Provider Demographics
NPI:1073931747
Name:NOUV, COLYN (DPM)
Entity Type:Individual
Prefix:
First Name:COLYN
Middle Name:
Last Name:NOUV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34627 SE SWENSON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-5199
Mailing Address - Country:US
Mailing Address - Phone:425-434-4851
Mailing Address - Fax:425-414-7032
Practice Address - Street 1:34627 SE SWENSON DR STE 101
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-5199
Practice Address - Country:US
Practice Address - Phone:510-283-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60721876213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2082072Medicaid