Healthcare Provider Details

I. General information

NPI: 1457636698
Provider Name (Legal Business Name): CORRIE MCDANIEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORRIE FLETCHER D.O.

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 SAND POINT WAY NE
SEATTLE WA
98105
US

IV. Provider business mailing address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5465
  • Fax:
Mailing address:
  • Phone: 206-987-7370
  • Fax: 206-985-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP 60466840
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number60466840
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: