Basic Information
| Provider Information | |||||||||
| NPI: | 1427709443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GERIATRIC PSYCHIATRY NORTHWEST PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15412 48TH STREET CT E | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983902835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539056877 | ||||||||
| FaxNumber: | 8776829319 | ||||||||
| Practice Location | |||||||||
| Address1: | 15412 48TH STREET CT E | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983902835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539056877 | ||||||||
| FaxNumber: | 8776829319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | LINDERMAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2539056877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DNP | ||||||||
| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.