Organization
WALLINGFORD PEDIATRICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH C NIEBLA (OFFICE MANAGER)
(206) 632-0542
Entity
Organization
Contact information
Practice address
4005 WALLINGFORD AVE N, SEATTLE, WA 98103-8218
(206) 632-0542
Mailing address
PO BOX 31509, SEATTLE, WA 98103
(206) 632-0542
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
MD00012418
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0057688
L & I
WA
01
—
1097559
DSHS
WA
Enumeration date
05/08/2008
Last updated
05/08/2008
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