Healthcare Provider Details

I. General information

NPI: 1609526177
Provider Name (Legal Business Name): NICHOLAS HASLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 06/21/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 ROOSEVELT WAY NE
SEATTLE WA
98105-6008
US

IV. Provider business mailing address

4800 SAND POINT WAY NE OC.7.830
SEATTLE WA
98105
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMDRE.ML.61291349
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: