Healthcare Provider Details

I. General information

NPI: 1992890503
Provider Name (Legal Business Name): HEIDI J IWANSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 NE 91ST ST
SEATTLE WA
98115-3696
US

IV. Provider business mailing address

3501 NE 91ST ST
SEATTLE WA
98115-3696
US

V. Phone/Fax

Practice location:
  • Phone: 206-557-1992
  • Fax: 206-557-1998
Mailing address:
  • Phone: 206-557-1992
  • Fax: 206-557-1998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60151743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: