Healthcare Provider Details

I. General information

NPI: 1518269059
Provider Name (Legal Business Name): KARINE JANELL DAVIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARINE JANELL WILDFANG

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 BOTHELL EVERETT HWY SUITE 260
EVERETT WA
98208-6642
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 425-316-5080
  • Fax:
Mailing address:
  • Phone: 866-366-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60172223
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: