Provider Demographics
NPI:1114118072
Name:CONVENIENT MEDICAL CARE
Entity Type:Organization
Organization Name:CONVENIENT MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUI
Authorized Official - Middle Name:
Authorized Official - Last Name:LETRAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-431-9334
Mailing Address - Street 1:316 B ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4001
Mailing Address - Country:US
Mailing Address - Phone:253-431-9334
Mailing Address - Fax:253-735-8833
Practice Address - Street 1:316 B ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4001
Practice Address - Country:US
Practice Address - Phone:253-431-9334
Practice Address - Fax:253-735-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004015261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center