Healthcare Provider Details

I. General information

NPI: 1336267806
Provider Name (Legal Business Name): KARA FAIRBANKS WARDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 HOYT AVE
EVERETT WA
98201-4918
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5408
  • Fax:
Mailing address:
  • Phone: 425-304-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60181780
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberMD60181780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: