Basic Information
| Provider Information | |||||||||
| NPI: | 1538187091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16259 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427900 | ||||||||
| FaxNumber: | 2062481551 | ||||||||
| Practice Location | |||||||||
| Address1: | 16259 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 504 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062427900 | ||||||||
| FaxNumber: | 2062481551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD00012093 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | P00206065 | 01 | RAILROAD MEDICARE # | OTHER | 1119940 | 05 | WA | MEDICAID |