Healthcare Provider Details

I. General information

NPI: 1285708982
Provider Name (Legal Business Name): JOELLEN ESTVOLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22603 NE INGLEWOOD HILL RD SUITE #100
SAMMAMISH WA
98074-7105
US

IV. Provider business mailing address

14711 NE 29TH PL SUITE #255
BELLEVUE WA
98007-7666
US

V. Phone/Fax

Practice location:
  • Phone: 425-836-5407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00025886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: