Provider Demographics
NPI:1982129490
Name:ARBORETUM DERMATOLOGY SEATTLE, PLLC
Entity Type:Organization
Organization Name:ARBORETUM DERMATOLOGY SEATTLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:NICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-523-2485
Mailing Address - Street 1:1861 MCGILVRA BLVD E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3123
Mailing Address - Country:US
Mailing Address - Phone:206-919-0198
Mailing Address - Fax:
Practice Address - Street 1:3131 E MADISON ST STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4266
Practice Address - Country:US
Practice Address - Phone:206-462-5850
Practice Address - Fax:206-487-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty