MEDICARE: MS. RAYLENE FELLOWS CANBY PA-C

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	363A00000X	Physician Assistant		WA

General Provider Information

NPI Number	:	1871552067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAYLENE FELLOWS CANBY PA-C

Provider Business Mailing Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:	112/OTO
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:	206-764-2359
Fax Number	:	206-764-2672

Provider Business Practice Location Address
First Line	:	1660 S COLUMBIAN WAY
Second Line	:	112/OTO
City	:	SEATTLE
State	:	WA
Zip	:	98108-1532
Country	:	US
Telephone Number	:	206-764-2359
Fax Number	:	206-764-2672

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	09/13/2007

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