Provider Demographics
NPI:1447727532
Name:SIEGAL, BROOKS STEVENS HOLTAN (LM, CPM)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:STEVENS HOLTAN
Last Name:SIEGAL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 EASTLAKE AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3707
Mailing Address - Country:US
Mailing Address - Phone:206-407-3397
Mailing Address - Fax:
Practice Address - Street 1:1500 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3707
Practice Address - Country:US
Practice Address - Phone:206-407-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60828887176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife