Healthcare Provider Details

I. General information

NPI: 1275182396
Provider Name (Legal Business Name): CLAIRE ANNE STREETER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 204
SEATTLE WA
98101-1726
US

IV. Provider business mailing address

523 28TH AVE E APT B
SEATTLE WA
98112-4146
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-5255
  • Fax:
Mailing address:
  • Phone: 203-252-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61002159
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: