Healthcare Provider Details

I. General information

NPI: 1205814167
Provider Name (Legal Business Name): VICTORIA BOISEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2006
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5708 E LAKE SAMMAMISH PKWY SE
ISSAQUAH WA
98029-8942
US

IV. Provider business mailing address

5708 E LAKE SAMMAMISH PKWY SE
ISSAQUAH WA
98029-8942
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-5277
  • Fax: 425-233-6268
Mailing address:
  • Phone: 425-688-5277
  • Fax: 425-233-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOPO60935786
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO166249
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11678
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60935786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: