1942397633 NPI number — SHEILA CAROL FERRELL ARNP

Table of content: SHEILA CAROL FERRELL ARNP (NPI 1942397633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942397633 NPI number — SHEILA CAROL FERRELL ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERRELL
Provider First Name:
SHEILA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRELL
Provider Other First Name:
SHELLY
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942397633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 N BROADWAY
Provider Second Line Business Mailing Address:
PBO
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-317-0699
Provider Business Mailing Address Fax Number:
425-317-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
916 PACIFIC AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-304-6159
Provider Business Practice Location Address Fax Number:
425-303-6550
Provider Enumeration Date:
10/06/2006

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: 363LF0000X , with the licence number:  AP30004466 , 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: 9637794 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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