Provider Demographics
NPI:1730835042
Name:THE KETAMINE CLINIC OF SEATTLE. LLC
Entity type:Organization
Organization Name:THE KETAMINE CLINIC OF SEATTLE. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINNOCK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CRNA, ND
Authorized Official - Phone:206-429-5029
Mailing Address - Street 1:3800 AURORA AVE N STE 360
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8721
Mailing Address - Country:US
Mailing Address - Phone:206-429-5029
Mailing Address - Fax:206-504-2044
Practice Address - Street 1:3800 AURORA AVE N STE 360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8721
Practice Address - Country:US
Practice Address - Phone:206-429-5029
Practice Address - Fax:206-504-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty