MEDICARE: BRIDGES SEATTLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1295413102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGES SEATTLE LLC

Provider Business Mailing Address
First Line	:	PO BOX 110255
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99511-0255
Country	:	US
Telephone Number	:	206-745-1191
Fax Number	:	888-467-5306

Provider Business Practice Location Address
First Line	:	1751 NE NAOMI PL
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6828
Country	:	US
Telephone Number	:	206-745-1191
Fax Number	:	888-467-5306

Authorized Official
Title or Position	:	MANAGER
Name	:	THERESA M RONCO
Credential	:
Telephone Number	:	907-771-0536

Provider Enumeration Date	:	07/10/2023
Last Update Date	:	07/10/2023

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Directions to “BRIDGES SEATTLE LLC ” Practice Location

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