Healthcare Provider Details

I. General information

NPI: 1346548963
Provider Name (Legal Business Name): SEATTLE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 11TH AVE E
SEATTLE WA
98102-5008
US

IV. Provider business mailing address

526 11TH AVE E
SEATTLE WA
98102-5008
US

V. Phone/Fax

Practice location:
  • Phone: 206-293-4120
  • Fax:
Mailing address:
  • Phone: 206-293-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberML60019662
License Number StateWA

VIII. Authorized Official

Name: DR. JENNIE MICHELLE ALLEN
Title or Position: CARDIOLOGY FELLOW
Credential: MD
Phone: 206-987-2266