Provider Demographics
NPI:1699712620
Name:FRUIN, MICHAEL (ARNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FRUIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 10TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2130
Mailing Address - Country:US
Mailing Address - Phone:206-768-7275
Mailing Address - Fax:
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:3 NORTH
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4379
Practice Address - Country:US
Practice Address - Phone:206-215-3958
Practice Address - Fax:206-386-2602
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003504363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AO9339Medicare UPIN