Provider Demographics
NPI:1417529470
Name:BROWN, NATALIE SUZANNE (LMP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUZANNE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 E SHOREWOOD DR APT 616
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-6268
Mailing Address - Country:US
Mailing Address - Phone:206-331-7742
Mailing Address - Fax:
Practice Address - Street 1:606 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3026
Practice Address - Country:US
Practice Address - Phone:425-455-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist