MEDICARE: PHIROCE ISHAQUE 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	363L00000X	Nurse Practitioner	AP 30006491	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00081924	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0177954	OTHER	WA	L&I

General Provider Information

NPI Number	:	1528051893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHIROCE ISHAQUE ARNP

Provider Business Mailing Address
First Line	:	PO BOX 98886
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98496-8886
Country	:	US
Telephone Number	:	253-589-6484
Fax Number	:	253-984-1079

Provider Business Practice Location Address
First Line	:	4901 108TH ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3724
Country	:	US
Telephone Number	:	253-589-6484
Fax Number	:	253-984-1079

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/18/2010

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Directions to “ PHIROCE ISHAQUE ARNP” Practice Location

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