Individual
BARBARA R FAYETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
21601 76TH AVE W, EDMONDS, WA 98026-7507
(425) 640-4000
(425) 640-4010
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10003948
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0190248
LIWA
WA
01
—
0220106
LIWA
WA
01
—
0259FA
LIWA
WA
01
—
1051FA
BSWA
WA
01
—
2595FA
BSWA
WA
05
—
8364093
—
WA
Enumeration date
06/03/2006
Last updated
02/23/2008
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