Basic Information
Provider Information | |||||||||
NPI: | 1376584748 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DEL FIERRO | ||||||||
FirstName: | SINDY | ||||||||
MiddleName: | I | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2601 CHERRY AVE | ||||||||
Address2: | STE 200 | ||||||||
City: | BREMERTON | ||||||||
State: | WA | ||||||||
PostalCode: | 983104203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3604159110 | ||||||||
FaxNumber: | 3604790265 | ||||||||
Practice Location | |||||||||
Address1: | 2601 CHERRY AVE | ||||||||
Address2: | STE 200 | ||||||||
City: | BREMERTON | ||||||||
State: | WA | ||||||||
PostalCode: | 983104203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3604159110 | ||||||||
FaxNumber: | 3604790265 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/09/2006 | ||||||||
LastUpdateDate: | 10/07/2013 | ||||||||
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 | 207P00000X | PA10003359 | WA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 363AS0400X | PA10003359 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
ID | Type | State | Issuer | Description | 0312552 | 01 | WA | LABOR & IND | OTHER |