Healthcare Provider Details

I. General information

NPI: 1215915723
Provider Name (Legal Business Name): NANCY JANE NEUBAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLBY AVE PROVIDENCE EVERETT MEDICAL CENTER
EVERETT WA
98206
US

IV. Provider business mailing address

19020 33RD AVE W STE 210
LYNNWOOD WA
98036-4748
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-2000
  • Fax:
Mailing address:
  • Phone: 425-563-1500
  • Fax: 425-563-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00038613
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: