MEDICARE: MATEA NICHOLE BURNS AU.D.

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	231H00000X	Audiologist	60881074	WA
2	231H00000X	Audiologist	LD60881074	WA

General Provider Information

NPI Number	:	1750863353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATEA NICHOLE BURNS AU.D.

Provider Business Mailing Address
First Line	:	11511 NE 10TH ST
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-8578
Country	:	US
Telephone Number	:	425-502-3000
Fax Number	:	425-502-3589

Provider Business Practice Location Address
First Line	:	418 1ST AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-4018
Country	:	US
Telephone Number	:	206-452-2224
Fax Number	:

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

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	09/30/2021

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