Healthcare Provider Details

I. General information

NPI: 1346442225
Provider Name (Legal Business Name): TIMOTHY MICHAEL PANEK ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33573 NE 42ND ST
CARNATION WA
98014-8747
US

IV. Provider business mailing address

33573 NE 42ND ST
CARNATION WA
98014-8747
US

V. Phone/Fax

Practice location:
  • Phone: 425-333-6743
  • Fax:
Mailing address:
  • Phone: 425-333-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: