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General NPI Number Information
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NPI Number | 1003169434
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Entity Type | Organization
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Legal Business Name | UROLOGY NORTHWEST, PS
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 3100 TONGASS AVE 3RD FLOOR VISITING CLINIC
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City | KETCHIKAN
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State | AK
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Zip | 99901-5746
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Country | US
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Telephone | 855-881-5319
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 244TH ST SW 111
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-5400
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Country | US
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Telephone | 425-275-5547
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Fax | 425-275-5593
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CANDY SHALON CHAPMAN
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Credential |
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Telephone | 425-275-5547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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