Provider Demographics
NPI:1295831162
Name:SEATTLE REPRODUCTIVE HEALTHCARE PS
Entity Type:Organization
Organization Name:SEATTLE REPRODUCTIVE HEALTHCARE PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISENCED PRACTICAL N
Authorized Official - Phone:206-328-3200
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:STE 840
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3539
Mailing Address - Country:US
Mailing Address - Phone:206-328-3200
Mailing Address - Fax:206-328-4636
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 840
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3539
Practice Address - Country:US
Practice Address - Phone:206-328-3200
Practice Address - Fax:206-328-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027147207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109671Medicaid
E72307Medicare UPIN
WAAB24514Medicare ID - Type Unspecified