Healthcare Provider Details

I. General information

NPI: 1730154584
Provider Name (Legal Business Name): ANKLE & FOOT CLINICS NORTHWEST, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 CHINOOK DR
EVERETT WA
98203-1376
US

IV. Provider business mailing address

4924 CHINOOK DR
EVERETT WA
98203-1376
US

V. Phone/Fax

Practice location:
  • Phone: 425-327-6603
  • Fax:
Mailing address:
  • Phone: 425-327-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL T CHRISTENSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-327-6603