Healthcare Provider Details

I. General information

NPI: 1366597932
Provider Name (Legal Business Name): SEATTLE REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WESTLAKE AVE N SUITE 400
SEATTLE WA
98109-3050
US

IV. Provider business mailing address

1505 WESTLAKE AVE N SUITE 400
SEATTLE WA
98109-3050
US

V. Phone/Fax

Practice location:
  • Phone: 206-301-5000
  • Fax: 206-285-4555
Mailing address:
  • Phone: 206-301-5000
  • Fax: 206-285-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number602352899
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRAD SENSTRA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 206-301-5001