Healthcare Provider Details

I. General information

NPI: 1508417536
Provider Name (Legal Business Name): BRIAN MACARAIG ORGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 DEXTER AVE N OFC 12
SEATTLE WA
98109-3534
US

IV. Provider business mailing address

1425 DEXTER AVE N OFC 12
SEATTLE WA
98109-3534
US

V. Phone/Fax

Practice location:
  • Phone: 580-969-0008
  • Fax:
Mailing address:
  • Phone: 580-969-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70008704
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95286394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: