Healthcare Provider Details

I. General information

NPI: 1518910124
Provider Name (Legal Business Name): PACIFIC NW FERTILITY AND IVF SPECIALISTS. I. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 1050
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

1101 MADISON ST SUITE 1050
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-515-0000
  • Fax: 206-515-0001
Mailing address:
  • Phone: 206-515-0000
  • Fax: 206-515-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: LEE R. HICKOK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 206-515-0000