Healthcare Provider Details

I. General information

NPI: 1700100385
Provider Name (Legal Business Name): COLLEEN ANNE CARETTE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N. WARNER ST. #1035
TACOMA WA
98416-1035
US

IV. Provider business mailing address

1500 N WARNER ST #1035
TACOMA WA
98416-1035
US

V. Phone/Fax

Practice location:
  • Phone: 253-879-1555
  • Fax: 253-879-3766
Mailing address:
  • Phone: 253-879-1555
  • Fax: 253-879-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004756
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: