Basic Information
| Provider Information | |||||||||
| NPI: | 1295012524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTSIDE CLINICAL CONSULTING | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 50150 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980150150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252285228 | ||||||||
| FaxNumber: | 4252285733 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S 43RD ST | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252283450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2011 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | STEVENSON | ||||||||
| AuthorizedOfficialFirstName: | QUYEN | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | ARNP | ||||||||
| AuthorizedOfficialTelephone: | 4252285228 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60110353 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.