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NPI Code Detail

MEDICARE: DR. CORAL D. HANEVOLD MD

MEDICARE:  DR. CORAL D. HANEVOLD  MD
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
12080P0210XPediatric Nephrology PhysicianMD00048253WA

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 : 1689784043
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORAL D. HANEVOLD MD
Provider Business Mailing Address
First Line : 4800 SAND POINT WAY NE
Second Line : MAILSTOP A-7931
City : SEATTLE
State : WA
Zip : 98105-3901
Country : US
Telephone Number : 206-987-2524
Fax Number : 206-987-2636
Provider Business Practice Location Address
First Line : 4800 SAND POINT WAY NE
Second Line : MAILSTOP A-7931
City : SEATTLE
State : WA
Zip : 98105-3901
Country : US
Telephone Number : 206-987-2524
Fax Number : 206-987-2636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 09/15/2007

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Directions to “ DR. CORAL D. HANEVOLD MD” Practice Location

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