Healthcare Provider Details

I. General information

NPI: 1801912241
Provider Name (Legal Business Name): FIDALGO ISLAND WALK-IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COMMERCIAL AVE
ANACORTES WA
98221-2235
US

IV. Provider business mailing address

1500 COMMERCIAL AVE
ANACORTES WA
98221-2235
US

V. Phone/Fax

Practice location:
  • Phone: 360-299-2650
  • Fax: 360-299-2651
Mailing address:
  • Phone: 360-299-2650
  • Fax: 360-299-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateWA

VIII. Authorized Official

Name: CATHERINE M MIZEN
Title or Position: MEDICAL DIRECTOR
Credential: ARNP
Phone: 360-299-2650