=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457411811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLASTIC SURGERY SEATTLE, PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 E JEFFERSON ST #510
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-5698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-320-2270
-----------------------------------------------------
Fax | 206-320-2101
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 E JEFFERSON ST #501
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98122-5698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-320-2270
-----------------------------------------------------
Fax | 206-320-2101
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT CARE COORDINATOR
-----------------------------------------------------
Name | MRS. JACKIE KNIPPEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 206-320-2270
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD00023270
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------