Healthcare Provider Details

I. General information

NPI: 1689787277
Provider Name (Legal Business Name): DIABETES MANAGEMENT NORTHWEST PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N WEST AVE
ARLINGTON WA
98223-1251
US

IV. Provider business mailing address

540 N WEST AVE
ARLINGTON WA
98223-1251
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-5365
  • Fax: 360-474-1394
Mailing address:
  • Phone: 360-435-5365
  • Fax: 360-474-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberRN00050644
License Number StateWA

VIII. Authorized Official

Name: KITTY L CARMICHAEL
Title or Position: ARNP
Credential:
Phone: 360-435-5365