=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942242342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORELINE FAMILY PRACTICE LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9776 HOLMAN RD NW SUITE 102
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98117-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-870-2367
-----------------------------------------------------
Fax | 360-403-3392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 77070
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98177-0070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-870-2367
-----------------------------------------------------
Fax | 360-403-3392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. STEVEN A CREELMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 425-870-2367
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------