MEDICARE: AME PHITWONG ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	AP60791082	WA
2	363L00000X	Nurse Practitioner	AP60791082	WA

General Provider Information

NPI Number	:	1255858247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AME PHITWONG ARNP

Provider Business Mailing Address
First Line	:	21727 76TH AVE W STE H
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	425-672-1333
Fax Number	:	425-672-7755

Provider Business Practice Location Address
First Line	:	21727 76TH AVE W STE H
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7549
Country	:	US
Telephone Number	:	425-672-1333
Fax Number	:	425-672-7755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	02/26/2020

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