Basic Information
| Provider Information | |||||||||
| NPI: | 1518456847 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH END MEDICAL PROFESSIONAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH END MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2557 TURNINGLEAF LN | ||||||||
| Address2: | |||||||||
| City: | OAK HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982778622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606327366 | ||||||||
| FaxNumber: | 3607202812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1186 S BURLINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982333314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606327366 | ||||||||
| FaxNumber: | 3607202812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2018 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLETCHER | ||||||||
| AuthorizedOfficialFirstName: | YVETTE | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3606327366 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH END MEDICAL PROFESSIONAL CORPORATION | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | ARNP, FNP-BCC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0106X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | 363LF0000X | AP30806622 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.