=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952553919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUICK CARE CLINIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2008
-----------------------------------------------------
Last Update Date | 10/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 W STATE ST
-----------------------------------------------------
City | SEDRO WOOLLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98284-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-856-5900
-----------------------------------------------------
Fax | 360-899-5916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 W STATE ST
-----------------------------------------------------
City | SEDRO WOOLLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98284-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-856-5900
-----------------------------------------------------
Fax | 360-899-5916
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | ROBYN MARGOT CHOFFEL
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 360-856-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 6026297777
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------