Healthcare Provider Details

I. General information

NPI: 1992782957
Provider Name (Legal Business Name): ANNE HERBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S. STILLAGUAMISH AVE
ARLINGTON WA
98223
US

IV. Provider business mailing address

1400 E. KINCAID STREET
MOUNT VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-2144
  • Fax: 360-435-9601
Mailing address:
  • Phone: 360-428-2500
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2005-0036
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60024900
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: