Basic Information
Provider Information | |||||||||
NPI: | 1174830806 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHILCOTE | ||||||||
FirstName: | JOY | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNM, MN, ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | LUTHER | ||||||||
OtherFirstName: | JOY | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3360 | ||||||||
Address2: |   | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 972083360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8663662983 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 916 PACIFIC AVE | ||||||||
Address2: | 2ND FLOOR | ||||||||
City: | EVERETT | ||||||||
State: | WA | ||||||||
PostalCode: | 982014147 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4253036500 | ||||||||
FaxNumber: | 4253036550 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/01/2010 | ||||||||
LastUpdateDate: | 02/06/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00131040 | WA | N |   | Nursing Service Providers | Registered Nurse |   | 367A00000X | AP60177838 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |   |
ID Information
ID | Type | State | Issuer | Description | AP60177838 | 01 | WA | WASHINGTON STATE LICENSE | OTHER | RN00131040 | 01 | WA | WASHINGTON STATE LICENSE | OTHER |