Healthcare Provider Details

I. General information

NPI: 1912794066
Provider Name (Legal Business Name): MICHAEL BRUCE CERNUSKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

IV. Provider business mailing address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

V. Phone/Fax

Practice location:
  • Phone: 206-668-1076
  • Fax: 206-668-1727
Mailing address:
  • Phone: 206-668-1076
  • Fax: 206-668-1727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number00000346
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: