Basic Information
| Provider Information | |||||||||
| NPI: | 1053448258 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST NASAL SINUS CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10330 MERIDIAN AVE N | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981339451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065252525 | ||||||||
| FaxNumber: | 2065250346 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 CARILLON PT | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980337306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4255761700 | ||||||||
| FaxNumber: | 4258277725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ALLEGRA | ||||||||
| AuthorizedOfficialFirstName: | ARLENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2065252525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD00047652 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | BU6816625 | 01 | WA | DEA LICENSE | OTHER | MD00047652 | 01 | WA | STATE MEDICAL LICENSE | OTHER |