Healthcare Provider Details

I. General information

NPI: 1275567919
Provider Name (Legal Business Name): NORTHWEST PHYSICIAN ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S STILLAGUAMISH AVE
ARLINGTON WA
98223-1642
US

IV. Provider business mailing address

PO BOX 634596
CINCINNATI OH
45263-4596
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-2133
  • Fax: 253-838-6418
Mailing address:
  • Phone: 800-562-2945
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHARON HARDY
Title or Position: DIRECTOR PROVIDER ENROLLMENT
Credential:
Phone: 925-251-6901