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NPI Code Detail

MEDICARE: CARL RYAN SCHICKERLING PA-C

MEDICARE: CARL RYAN SCHICKERLING PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA60952862WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1174002240
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARL RYAN SCHICKERLING PA-C
Provider Business Mailing Address
First Line : PO BOX 25608
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84125-0608
Country : US
Telephone Number : 206-320-4476
Fax Number : 206-568-7043
Provider Business Practice Location Address
First Line : 1221 MADISON ST STE 1523
Second Line :
City : SEATTLE
State : WA
Zip : 98104-1342
Country : US
Telephone Number : 206-320-4476
Fax Number : 206-568-7043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2018
Last Update Date : 11/20/2023

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