Individual
JOY R FACKENTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7205 265TH ST NW, STANWOOD, WA 98292-6221
(360) 629-1504
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 258-3900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37986
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1008993
—
WA
01
—
37986
LICENSE
WA
Enumeration date
10/23/2006
Last updated
12/11/2012
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