MEDICARE: MISS ANGELA MACCARRONE MS, INTERN

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1437628773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELA MACCARRONE MS, INTERN

Provider Business Mailing Address
First Line	:	6400 SOUTHCENTER BLVD
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2547
Country	:	US
Telephone Number	:	206-901-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 N HOLY NAMES CT
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99224-5803
Country	:	US
Telephone Number	:	509-960-8653
Fax Number	:	509-455-4988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	07/31/2023

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