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General NPI Number Information
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NPI Number | 1417175811
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP, INC PS
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 12728 19TH AVE SE STE 300
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City | EVERETT
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State | WA
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Zip | 98208-6676
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Country | US
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Telephone | 425-258-6801
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Fax | 425-258-1944
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Provider Business Mailing Address
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Address Line | 12728 19TH AVE SE STE 300
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City | EVERETT
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State | WA
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Zip | 98208-6676
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Country | US
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Telephone | 425-252-1116
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Fax | 425-252-1118
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Authorized Official
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Title or Position | HIPPA PRIVACY OFFICER
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Name | MS. VICKI MCGINNIS
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Credential |
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Telephone | 425-259-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 601474013
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License Number State | WA
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