Healthcare Provider Details

I. General information

NPI: 1427384429
Provider Name (Legal Business Name): MICHI E NAIR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST STE 1400
SEATTLE WA
98104-4308
US

IV. Provider business mailing address

1101 MADISON ST STE 1400
SEATTLE WA
98104-4308
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-6266
  • Fax: 206-386-2844
Mailing address:
  • Phone: 206-386-6266
  • Fax: 206-386-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60107990
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60107990
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: