Healthcare Provider Details

I. General information

NPI: 1154153153
Provider Name (Legal Business Name): SEBASTIAN JEREMY DANIEL DORRANCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 E MARGINAL WAY S STE C110
SEATTLE WA
98134-2341
US

IV. Provider business mailing address

10732 8TH AVE NE APT 5
SEATTLE WA
98125-7280
US

V. Phone/Fax

Practice location:
  • Phone: 206-971-8830
  • Fax:
Mailing address:
  • Phone: 219-316-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: