Provider Demographics
NPI:1720019094
Name:ACKER, MICHELE E (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:E
Last Name:ACKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:E
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:319 NE 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3735
Mailing Address - Country:US
Mailing Address - Phone:206-390-4308
Mailing Address - Fax:
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2728
Practice Address - Fax:206-987-2060
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00058280163W00000X
WAAP30003692363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA28888UOtherREGENCE BLUE SHIELD PIN
WA0171998OtherL&I PIN
WA9615329Medicaid
WA0171998OtherL&I PIN
WAAB38347Medicare PIN