Healthcare Provider Details

I. General information

NPI: 1164326450
Provider Name (Legal Business Name): IMPALA MARIE MARSEILLE CHEESEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 CALIFORNIA AVE SW
SEATTLE WA
98136-2315
US

IV. Provider business mailing address

7909 CALIFORNIA AVE SW
SEATTLE WA
98136-2315
US

V. Phone/Fax

Practice location:
  • Phone: 206-696-2934
  • Fax:
Mailing address:
  • Phone: 206-696-2934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70187590-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: