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General NPI Number Information
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NPI Number | 1649861881
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Entity Type | Organization
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Legal Business Name | EASTSIDE HEALTHCARE, LLC
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Dates
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Enumeration Date | 01/31/2021
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Last Update Date | 01/31/2021
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Provider Practice Location Address
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Address Line | 1420 NW GILMAN BLVD SUITE 2, #8088
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City | ISSAQUAH
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State | WA
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Zip | 98027
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Country | US
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Telephone | 360-581-5987
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 NW GILMAN BLVD SUITE 2, #8088
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City | ISSAQUAH
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State | WA
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Zip | 98027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | BREANNE VAN VOAST
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Credential | ARNP
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Telephone | 360-581-5987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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