Healthcare Provider Details

I. General information

NPI: 1801404124
Provider Name (Legal Business Name): NORTHWEST KIDNEY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SE EVERETT MALL WAY STE 104
EVERETT WA
98208-2855
US

IV. Provider business mailing address

12901 20TH AVE S
SEATAC WA
98168-5159
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-2771
  • Fax:
Mailing address:
  • Phone: 206-720-8508
  • Fax: 206-860-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ESLAVA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 206-292-2771