MEDICARE: MRS. ELIZABETH BROOKE REPASS SCM

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1669461596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH BROOKE REPASS SCM

Provider Business Mailing Address
First Line	:	1135 116TH AVE NE
Second Line	:	SUITE 320
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-990-6254
Fax Number	:	425-688-8110

Provider Business Practice Location Address
First Line	:	1135 116TH AVE NE
Second Line	:	SUITE 320
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-990-6254
Fax Number	:	425-688-8110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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