Healthcare Provider Details

I. General information

NPI: 1841600525
Provider Name (Legal Business Name): CARLY ROSE MAGNUSSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY ROSE TURGEON MD

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 SENECA ST
SEATTLE WA
98101-2742
US

IV. Provider business mailing address

925 SENECA ST
SEATTLE WA
98101-2742
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0860
  • Fax:
Mailing address:
  • Phone: 206-341-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMDRE.ML.60469854
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberML60469854
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD60776920
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: