MEDICARE: PHASES CLINIC, PLLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1629833900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHASES CLINIC, PLLC

Provider Business Mailing Address
First Line	:	15820 9TH AVE NE
Second Line	:
City	:	SHORELINE
State	:	WA
Zip	:	98155-6245
Country	:	US
Telephone Number	:	513-675-3702
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W NORTH BEND WAY STE 200
Second Line	:
City	:	NORTH BEND
State	:	WA
Zip	:	98045-8169
Country	:	US
Telephone Number	:	425-835-2726
Fax Number	:	833-450-6079

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA L WEILAND
Credential	:	NP
Telephone Number	:	513-675-3702

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	07/02/2024

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