Healthcare Provider Details

I. General information

NPI: 1083672513
Provider Name (Legal Business Name): TERESA Y SOUCIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

2819 26TH AVE W
SEATTLE WA
98199-2817
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-3717
  • Fax:
Mailing address:
  • Phone: 206-301-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003244
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: