Organization
UROLOGY NORTHWEST, PS
Active
Organization
UROLOGY NORTHWEST, PS
Active
Parent organization
UROLOGY NORTHWEST, PS
Other names
Urology Northwest, PS AK
Organization subpart
Yes
Provider details
NPI number
Legal business name
UROLOGY NORTHWEST, PS
Authorized official
CANDY SHALON CHAPMAN (ADMINISTRATOR)
(425) 275-5547
Entity
Organization
Contact information
Practice address
3100 TONGASS AVE, 3RD FLOOR VISITING CLINIC, KETCHIKAN, AK 99901-5746
(855) 881-5319
Mailing address
6005 244TH ST SW, 111, MOUNTLAKE TERRACE, WA 98043-5400
(425) 275-5547
(425) 275-5593
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MPG0374
—
AK
Enumeration date
10/23/2012
Last updated
10/23/2012
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