Provider Demographics
NPI:1366833147
Name:HAPPENNY, MICHELLE M (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:HAPPENNY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E JEFFERSON ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5648
Mailing Address - Country:US
Mailing Address - Phone:206-320-4888
Mailing Address - Fax:206-320-4203
Practice Address - Street 1:1600 E JEFFERSON ST STE 510
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5648
Practice Address - Country:US
Practice Address - Phone:206-320-4888
Practice Address - Fax:206-320-4203
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-14
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60971132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366833147Medicaid