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General NPI Number Information
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NPI Number | 1700665288
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Entity Type | Organization
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Legal Business Name | ANNEMARIE AESTHETICS PLLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 15015 MAIN ST STE 109
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City | BELLEVUE
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State | WA
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Zip | 98007-5229
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Country | US
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Telephone | 509-824-6978
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Fax |
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Provider Business Mailing Address
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Address Line | 15015 MAIN ST STE 109
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City | BELLEVUE
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State | WA
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Zip | 98007-5229
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Country | US
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Telephone | 509-824-6978
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Fax | 509-824-6961
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Authorized Official
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Title or Position | OWNER
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Name | ANNE MARIE FOMBU
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Credential |
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Telephone | 240-477-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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