Provider Demographics
NPI:1962114025
Name:NEUBAUER, MICHAEL D (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 NE 168TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-6131
Mailing Address - Country:US
Mailing Address - Phone:360-201-5452
Mailing Address - Fax:
Practice Address - Street 1:5410 NE WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2161
Practice Address - Country:US
Practice Address - Phone:360-201-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60926350163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health