Healthcare Provider Details

I. General information

NPI: 1396360699
Provider Name (Legal Business Name): SHEILA THERESE MCCOOL CAREGIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 EVERGREEN WAY STE 25179
EVERETT WA
98204-3885
US

IV. Provider business mailing address

10121 EVERGREEN WAY STE 25179
EVERETT WA
98204-3885
US

V. Phone/Fax

Practice location:
  • Phone: 206-331-5259
  • Fax:
Mailing address:
  • Phone: 206-331-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: