Healthcare Provider Details

I. General information

NPI: 1740341338
Provider Name (Legal Business Name): CHRISTINE Y TERRY PHYSCIANS ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21822 76TH AVE W
EDMONDS WA
98026-7900
US

IV. Provider business mailing address

21822 76TH AVE W
EDMONDS WA
98026-7900
US

V. Phone/Fax

Practice location:
  • Phone: 425-775-7166
  • Fax: 425-672-8844
Mailing address:
  • Phone: 425-775-7166
  • Fax: 425-672-8844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10005130
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: