Provider Demographics
NPI:1023395795
Name:NEW, WILLIAM KEVIN (ANP-BC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:NEW
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2720 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4762
Mailing Address - Country:US
Mailing Address - Phone:206-720-2315
Mailing Address - Fax:206-720-2338
Practice Address - Street 1:2720 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4739
Practice Address - Country:US
Practice Address - Phone:206-720-2315
Practice Address - Fax:206-720-2338
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60752872363LA2200X
DC1016730363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236503Y7HMedicare UPIN