is a Medical in Edmonds, Washington. practices all healthcare services and medical treatments related to Medical. The NPI Number for is 1699726273. The last update date is .
's current location address is 21911 76th Ave W, Edmonds, Washington. You can contact this provider via phone number 4256404950 and fax number 4256404958. The mailing address for is 21911 76th Ave W, Edmonds, Washington. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 21911 76th Ave W, Edmonds, Washington |
| Phone Number | 4256404950 |
| Fax Number | 4256404958 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1699726273 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 21911 76th Ave W |
|---|---|
| City | Edmonds |
| State | Washington (WA) |
| Post Code | 980267903 |
| Phone Number | 4256404950 |
| Fax Number | 4256404958 |
Provider's Primary Taxonomy Detail
| Speciality | Medical |
|---|---|
| Taxonomy | 363Am0700X |
| Licence No | PA10003257 |
|
Definition: A licensed healthcare professional who practices medicine under physician supervision focusing on medical diagnoses and treatment. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| NI5150 | WA | REGENCE BLUE SHIELD |
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