Healthcare Provider Details

I. General information

NPI: 1699712620
Provider Name (Legal Business Name): MICHAEL FRUIN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY 3 NORTH
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

8102 10TH AVE SW
SEATTLE WA
98106-2130
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-3958
  • Fax: 206-386-2602
Mailing address:
  • Phone: 206-768-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003504
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: