Basic Information
| Provider Information | |||||||||
| NPI: | 1467545632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBAUM | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | ARNP NURSE PRACTITIO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2112 N 36TH | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2066342146 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10501 N MERIDIAN | ||||||||
| Address2: | NORTH PUBLIC HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062964990 | ||||||||
| FaxNumber: | 2062055142 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP30004266 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 9618904 | 05 | WA | MEDICAID | MG0750299 | 01 | DEA | OTHER |