Healthcare Provider Details

I. General information

NPI: 1801334248
Provider Name (Legal Business Name): MORISSA PERTIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 08/27/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 JEFFERSON ST SUITE 11NJ-1166
SEATTLE WA
98104-2433
US

IV. Provider business mailing address

325 9TH AVE # 359928
SEATTLE WA
98104-2499
US

V. Phone/Fax

Practice location:
  • Phone: 206-520-4340
  • Fax:
Mailing address:
  • Phone: 206-520-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61081973
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11105298-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: