Healthcare Provider Details

I. General information

NPI: 1093220147
Provider Name (Legal Business Name): SONJA LYNN CAROTHERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 BROADWAY
EVERETT WA
98201-4425
US

IV. Provider business mailing address

PO BOX 3810
EVERETT WA
98213-8810
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-8359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number60770462
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: