Healthcare Provider Details

I. General information

NPI: 1174190581
Provider Name (Legal Business Name): CARRIE NICOLE DE VAULT CPC, CPRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2021
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16225 NE 87TH ST STE 160
REDMOND WA
98052-3536
US

IV. Provider business mailing address

451 4TH AVE S APT 307
KIRKLAND WA
98033-3610
US

V. Phone/Fax

Practice location:
  • Phone: 206-901-2000
  • Fax:
Mailing address:
  • Phone: 206-280-6312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: