Healthcare Provider Details

I. General information

NPI: 1679277636
Provider Name (Legal Business Name): PNW VIRTUAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 11TH AVE
SEATTLE WA
98122-3903
US

IV. Provider business mailing address

505 BROADWAY E STE 437
SEATTLE WA
98102-5023
US

V. Phone/Fax

Practice location:
  • Phone: 206-465-8454
  • Fax:
Mailing address:
  • Phone: 206-465-8454
  • Fax: 866-268-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN JONES
Title or Position: OWNER/ARNP
Credential: ARNP
Phone: 206-465-8454