MEDICARE: EDNORAH M ARVELO 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
1	363A00000X	Physician Assistant	PA10003490	WA

Other Identifiers

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

General Provider Information

NPI Number	:	1558365296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNORAH M ARVELO PA-C

Provider Business Mailing Address
First Line	:	11025 CANYON RD E
Second Line	:	SUITE A
City	:	PUYALLUP
State	:	WA
Zip	:	98373-4268
Country	:	US
Telephone Number	:	253-548-0453
Fax Number	:	253-548-3049

Provider Business Practice Location Address
First Line	:	11025 CANYON RD E
Second Line	:	SUITE A
City	:	PUYALLUP
State	:	WA
Zip	:	98373-4268
Country	:	US
Telephone Number	:	253-548-0453
Fax Number	:	253-548-3049

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	02/13/2008

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