Healthcare Provider Details

I. General information

NPI: 1871688689
Provider Name (Legal Business Name): CAROL DILLON MCCAHON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL J DILLON ARNP

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N. BROADWAY
EVERETT WA
98201
US

IV. Provider business mailing address

PO BOX 3360
PORTLAND OR
97208-3360
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-0310
  • Fax: 425-317-0303
Mailing address:
  • Phone: 866-366-2983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number08472
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60107871
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: