Healthcare Provider Details

I. General information

NPI: 1376308106
Provider Name (Legal Business Name): SLEEP DIAGNOSTICS NW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16410 SMOKEY POINT BLVD STE 106
ARLINGTON WA
98223-7079
US

IV. Provider business mailing address

16410 SMOKEY POINT BLVD STE 106
ARLINGTON WA
98223-7079
US

V. Phone/Fax

Practice location:
  • Phone: 619-405-3219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEMMA BOCKENKAMP
Title or Position: MANAGER
Credential:
Phone: 360-631-4437