Individual
HA TA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1415 E KINCAID ST, SKAGIT VALLEY HOSPITAL, HOSPITALISTS OFFICE, MOUNT VERNON, WA 98274-4126
(360) 416-5750
(360) 416-5758
Mailing address
1400 E KINCAID ST, SKAGIT REGIONAL CLINICS, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0429415
KS
207R00000X
Internal Medicine Physician
Primary
MD60287362
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100400710A
—
KS
05
—
1568437069
—
WA
01
—
309609
LABOR & INDUSTRIES
WA
Enumeration date
02/20/2006
Last updated
02/13/2014
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