Healthcare Provider Details

I. General information

NPI: 1942588843
Provider Name (Legal Business Name): TERESA J MCCOY RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 RUCKER AVE
EVERETT WA
98201-3931
US

IV. Provider business mailing address

3901 HOYT AVE
EVERETT WA
98201-4918
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-4650
  • Fax:
Mailing address:
  • Phone: 425-258-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00072920
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: