Provider Demographics
NPI:1114469855
Name:WILLOW FIBROMYALGIA AND HYPERMOBILITY CLINIC PLLC
Entity Type:Organization
Organization Name:WILLOW FIBROMYALGIA AND HYPERMOBILITY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEDEA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-734-4981
Mailing Address - Street 1:4520 FAUNTLEROY WAY SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2740
Mailing Address - Country:US
Mailing Address - Phone:206-734-4981
Mailing Address - Fax:888-734-4981
Practice Address - Street 1:4520 FAUNTLEROY WAY SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2740
Practice Address - Country:US
Practice Address - Phone:206-734-4981
Practice Address - Fax:888-734-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9659145Medicaid
1487719597OtherINDIVIDUAL PROVIDER NPI FOR MEDEA KARR ARNP