| Nvelup Telehealth Pllc | |
|
1455 Northwest Leary Way Suite 400-#101 Seattle WA 98107-9810 | |
| (509) 242-9202 | |
| (360) 991-0265 |
| Full Name | Nvelup Telehealth Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1455 Northwest Leary Way, Seattle, Washington |
| Authorized Official Name and Position | Troy Di Lello (COO) |
| Authorized Official Contact | 5092429202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nvelup Telehealth Pllc Po Box 7221 Petaluma CA 94955-7221 Ph: (509) 242-9202 | Nvelup Telehealth Pllc 1455 Northwest Leary Way Suite 400-#101 Seattle WA 98107-9810 Ph: (509) 242-9202 |
| NPI Number | 1356952766 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 07/16/2025 |
| Certification Date | 07/16/2025 |
| Medicare PECOS PAC ID | 7719398569 |
|---|---|
| Medicare Enrollment ID | O20201130000924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356952766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ginette Didomenico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558764233 PECOS PAC ID: 8325362569 Enrollment ID: I20150119000205 |
| Provider Name | Gregory C Mabry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477851475 PECOS PAC ID: 1658758289 Enrollment ID: I20220519001551 |
| Provider Name | Sara Zajac |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770904732 PECOS PAC ID: 6800261470 Enrollment ID: I20230412003072 |
| Provider Name | Karen A Schaaf |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295704484 PECOS PAC ID: 8628099561 Enrollment ID: I20230804000219 |
| Provider Name | Marcie Eynon |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679215966 PECOS PAC ID: 3870033129 Enrollment ID: I20240912003430 |
| Provider Name | Amber Bajema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457061962 PECOS PAC ID: 2860928074 Enrollment ID: I20241211003385 |
| Provider Name | Daniel Halter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962828681 PECOS PAC ID: 4880818079 Enrollment ID: I20241227000546 |
| Provider Name | Brittany Alyson Henness |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265979991 PECOS PAC ID: 9133514771 Enrollment ID: I20250402001393 |
| Provider Name | Joleen Johanson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588079081 PECOS PAC ID: 3173047099 Enrollment ID: I20250411002020 |
| Provider Name | Heidi Ann Fanslow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003638255 PECOS PAC ID: 5799212361 Enrollment ID: I20250528003639 |
| Provider Name | Jeremy Winston Gunn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871085142 PECOS PAC ID: 1951820349 Enrollment ID: I20250529000741 |
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