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General NPI Number Information
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NPI Number | 1477061844
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Entity Type | Organization
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Legal Business Name | CASCADE ALLERGY CENTER
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 01/18/2018
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Provider Practice Location Address
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Address Line | 14205 SE 36TH ST STE 365
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City | BELLEVUE
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State | WA
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Zip | 98006-1596
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Country | US
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Telephone | 206-261-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 14205 SE 36TH ST STE 365
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City | BELLEVUE
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State | WA
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Zip | 98006-1596
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING/ADMINISTRATION
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Name | VICKIE WEDLOCK
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Credential |
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Telephone | 206-261-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP60118915
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License Number State | WA
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