Provider Demographics
NPI:1124222559
Name:NORTHWEST EVALUATION AND CONSULTATION SERVICES INCORPORATED
Entity Type:Organization
Organization Name:NORTHWEST EVALUATION AND CONSULTATION SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FANSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, PHD
Authorized Official - Phone:253-927-2130
Mailing Address - Street 1:5608 17TH STREET CT NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-3446
Mailing Address - Country:US
Mailing Address - Phone:253-927-2130
Mailing Address - Fax:253-952-3049
Practice Address - Street 1:5608 17TH STREET CT NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-3446
Practice Address - Country:US
Practice Address - Phone:253-927-2130
Practice Address - Fax:253-952-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004806363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1346267051OtherNPI NUMBER
WA9637398Medicaid
WA1346267051OtherNPI NUMBER
WAG8865380Medicare PIN
WAS64530Medicare UPIN
WAG8865381Medicare PIN