1114942232 NPI number — CHERYL PARKER PA-C

Table of content: CHERYL PARKER PA-C (NPI 1114942232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114942232 NPI number — CHERYL PARKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARKER
Provider First Name:
CHERYL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114942232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11550 STONE AVE N
Provider Second Line Business Mailing Address:
204
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-1513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-985-8883
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CHILDREN'S HOSPITAL AND REGIONAL MEDICAL CENTER
Provider Second Line Business Practice Location Address:
4800 SAND POINT WAY NE M/S W7706
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-987-1272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA10004200 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8358491 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: N/A , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4301391 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".