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NPI Code Detail

MEDICARE: XIMENA WIESSE EGOAVIL LSWAIC

MEDICARE: XIMENA WIESSE EGOAVIL LSWAIC
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
1104100000XSocial WorkerSC 60433152WA

General Provider Information

NPI Number : 1336544717
Entity Type Code : Individual
Provider Name (Legal Business Name) : XIMENA WIESSE EGOAVIL LSWAIC
Provider Business Mailing Address
First Line : 3808 S ANGELINE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1712
Country : US
Telephone Number : 206-735-5476
Fax Number :
Provider Business Practice Location Address
First Line : 3808 S ANGELINE ST
Second Line :
City : SEATTLE
State : WA
Zip : 98118-1712
Country : US
Telephone Number : 206-735-5476
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2014
Last Update Date : 07/20/2020

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