Healthcare Provider Details

I. General information

NPI: 1164010823
Provider Name (Legal Business Name): MISS HOPE ELIZABETH WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 4TH AVE STE 450
SEATTLE WA
98121-3205
US

IV. Provider business mailing address

1800 N 107TH ST APT 5F
SEATTLE WA
98133-2820
US

V. Phone/Fax

Practice location:
  • Phone: 206-268-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: