Healthcare Provider Details

I. General information

NPI: 1952597635
Provider Name (Legal Business Name): VA PUGET SOUND HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108
US

IV. Provider business mailing address

1216 NE 68TH STREET
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-762-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License NumberRN00174846
License Number StateWA

VIII. Authorized Official

Name: MISS JULIE ANN HENDRICKS
Title or Position: REGISTERED NURSE
Credential:
Phone: 206-322-1730