Healthcare Provider Details

I. General information

NPI: 1982659959
Provider Name (Legal Business Name): NORTHWEST EAR, NOSE & THROAT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 MERIDIAN AVE N SUITE 190
SEATTLE WA
98133-9451
US

IV. Provider business mailing address

10330 MERIDIAN AVE N SUITE 190
SEATTLE WA
98133-9451
US

V. Phone/Fax

Practice location:
  • Phone: 206-389-7100
  • Fax: 206-389-7101
Mailing address:
  • Phone: 206-389-7100
  • Fax: 206-389-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateWA

VIII. Authorized Official

Name: GLYNIS L. THAKUR
Title or Position: CONSULTANT
Credential:
Phone: 206-352-5705