| Innovative Sleep Centers, Pllc | |
|
260 Lee St Sw Tumwater WA 98501-4403 | |
| (360) 754-3825 | |
| (360) 754-3835 |
| Full Name | Innovative Sleep Centers, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 260 Lee St Sw, Tumwater, Washington |
| Authorized Official Name and Position | Mehrdad Razavi (PRESIDENT) |
| Authorized Official Contact | 4255164749 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Sleep Centers, Pllc 260 Lee St Sw Tumwater WA 98501-4403 Ph: (360) 754-3825 | Innovative Sleep Centers, Pllc 260 Lee St Sw Tumwater WA 98501-4403 Ph: (360) 754-3825 |
| NPI Number | 1083925168 |
|---|---|
| Provider Enumeration Date | 06/23/2010 |
| Last Update Date | 07/18/2016 |
| Medicare PECOS PAC ID | 6103010392 |
|---|---|
| Medicare Enrollment ID | O20101102000134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083925168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Secondary |
| 2084S0012X | Psychiatry & Neurology - Sleep Medicine | (* (Not Available)) | Primary |
| Provider Name | Judith F Dant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659455178 PECOS PAC ID: 3971567041 Enrollment ID: I20041118000002 |
| Provider Name | Chrissie C Russell-wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942484308 PECOS PAC ID: 3072696350 Enrollment ID: I20080208000523 |
| Provider Name | Mehrdad Razavi |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1609857788 PECOS PAC ID: 7911917034 Enrollment ID: I20091201000375 |
| Provider Name | Harrison H Detroja |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154670628 PECOS PAC ID: 9739338245 Enrollment ID: I20121130000424 |
| Provider Name | Christopher K. Cheng |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1700175312 PECOS PAC ID: 8426320755 Enrollment ID: I20180720000866 |
| Provider Name | Abigail E Mercure |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740889369 PECOS PAC ID: 3375943590 Enrollment ID: I20210609003081 |
| Provider Name | Erica Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205373883 PECOS PAC ID: 1557617966 Enrollment ID: I20210915003629 |
| Provider Name | Donna Leigh Talan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548584873 PECOS PAC ID: 9234565029 Enrollment ID: I20220421002421 |
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