Healthcare Provider Details

I. General information

NPI: 1760018741
Provider Name (Legal Business Name): MICHELLE JEAN BARTLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC NEONATAL
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 267-590-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61057202
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMT228846
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: