Healthcare Provider Details

I. General information

NPI: 1447067079
Provider Name (Legal Business Name): CHLOE LORAINE BACIK RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

307 W MARION ST
ARLINGTON WA
98223-8275
US

V. Phone/Fax

Practice location:
  • Phone: 425-595-3822
  • Fax: 425-257-1423
Mailing address:
  • Phone: 425-361-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN60810966
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: