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General NPI Number Information
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NPI Number | 1114118072
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Entity Type | Organization
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Legal Business Name | CONVENIENT MEDICAL CARE
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 316 B ST NE
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City | AUBURN
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State | WA
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Zip | 98002-4001
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Country | US
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Telephone | 253-431-9334
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Fax | 253-735-8833
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Provider Business Mailing Address
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Address Line | 316 B ST NE
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City | AUBURN
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State | WA
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Zip | 98002-4001
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Country | US
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Telephone | 253-431-9334
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Fax | 253-735-8833
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Authorized Official
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Title or Position | ARNP/OWNER
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Name | MS. JACQUI LETRAN
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Credential | ARNP
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Telephone | 253-431-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AP30004015
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License Number State | WA
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