Individual
PHIROCE ISHAQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
4901 108TH ST SW, LAKEWOOD, WA 98499-3724
(253) 589-6484
(253) 984-1079
Mailing address
PO BOX 98886, LAKEWOOD, WA 98496-8886
(253) 589-6484
(253) 984-1079
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP 30006491
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0177954
L&I
WA
05
—
9638206
—
WA
01
—
P00081924
RR MEDICARE
WA
Enumeration date
08/23/2005
Last updated
03/18/2010
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