Organization Name: | BREATHE PEDIATRICS, PLLC |
NPI Number: | 1023407715 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY JEAN BAIN (PEDIATRIC NURSE PRACTITIONER) |
Mailing Address: | 175 1st Pl Nw Suite A Issaquah |
State: | WA US |
Postal Code: | 980272744 |
Phone Number: | 4256514044 |
Fax Number: | 4256514033 |
NPI Enumeration Date: | 01/18/2015 |
NPI Last Update Date: | 01/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | AP60455433 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |