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General NPI Number Information
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NPI Number | 1932327335
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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 | 08/04/2023
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Provider Practice Location Address
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Address Line | 3802 BROADWAY STE B
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City | EVERETT
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State | WA
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Zip | 98201-5032
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Country | US
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Telephone | 425-259-0855
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Fax | 425-259-0856
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Provider Business Mailing Address
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Address Line | 1728 W MARINE VIEW DR STE 110
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City | EVERETT
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State | WA
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Zip | 98201-2094
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Country | US
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Telephone | 425-259-0855
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Fax | 425-259-0856
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT FINANCIAL SVCS
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Name | AMELIA EDENS
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Credential |
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Telephone | 425-740-4142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 601474013
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License Number State | WA
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