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General NPI Number Information
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NPI Number | 1255858247
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Entity Type | Individual
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Provider Name | AME PHITWONG ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 21727 76TH AVE W STE H
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City | EDMONDS
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State | WA
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Zip | 98026-7549
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Country | US
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Telephone | 425-672-1333
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Fax | 425-672-7755
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Provider Business Mailing Address
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Address Line | 21727 76TH AVE W STE H
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City | EDMONDS
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State | WA
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Zip | 98026-7549
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Country | US
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Telephone | 425-672-1333
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Fax | 425-672-7755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | AP60791082
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60791082
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License Number State | WA
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