Provider Demographics
NPI:1609238930
Name:PORTACCI, AMY (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PORTACCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10601 5TH AVE NE
Mailing Address - Street 2:STE 201 WEST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7025
Mailing Address - Country:US
Mailing Address - Phone:206-287-6400
Mailing Address - Fax:206-341-1801
Practice Address - Street 1:10601 5TH AVE NE
Practice Address - Street 2:STE 201 WEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7025
Practice Address - Country:US
Practice Address - Phone:206-287-6400
Practice Address - Fax:206-341-1801
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2021-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60943581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine