Healthcare Provider Details

I. General information

NPI: 1447727532
Provider Name (Legal Business Name): BROOKS STEVENS HOLTAN SIEGAL LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2018
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EASTLAKE AVE E
SEATTLE WA
98102-3707
US

IV. Provider business mailing address

1500 EASTLAKE AVE E
SEATTLE WA
98102-3707
US

V. Phone/Fax

Practice location:
  • Phone: 206-407-3397
  • Fax:
Mailing address:
  • Phone: 206-407-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60828887
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: