Provider Demographics
NPI:1568142289
Name:IAM CENTER FOR INTEGRATIVE AESTHETIC MEDICINE
Entity Type:Organization
Organization Name:IAM CENTER FOR INTEGRATIVE AESTHETIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP-BC
Authorized Official - Phone:425-502-7916
Mailing Address - Street 1:1550 140TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4500
Mailing Address - Country:US
Mailing Address - Phone:425-502-7916
Mailing Address - Fax:
Practice Address - Street 1:1550 140TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4500
Practice Address - Country:US
Practice Address - Phone:425-502-7916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty