Basic Information
| Provider Information | |||||||||
| NPI: | 1366645947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOYD | ||||||||
| FirstName: | ANNELIESE | ||||||||
| MiddleName: | HERSETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 W ORCHARD DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603188800 | ||||||||
| FaxNumber: | 3603181085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2075 BARKLEY BLVD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982266614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606713345 | ||||||||
| FaxNumber: | 3606501354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00048880 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ML20008318 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2075FL | 01 | WA | REGENCE | OTHER | 8949110 | 01 | WA | L&I CRIME VICTIMS | OTHER | 0241356 | 01 | WA | L&I REGULAR | OTHER | 8525735 | 05 | WA | MEDICAID |