Basic Information
Provider Information
NPI: 1295133429
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENGLEHART
FirstName: DENISE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 905 SPRUCE ST
Address2: SUITE 300
City: SEATTLE
State: WA
PostalCode: 981042474
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 6020 35TH AVE SW
Address2:  
City: SEATTLE
State: WA
PostalCode: 981263002
CountryCode: US
TelephoneNumber: 2064616950
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2014
LastUpdateDate: 12/22/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP30001479WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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