Provider Demographics
NPI:1225073935
Name:COAD, ALICE J (ARNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:COAD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14048 JUANITA DR NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5312
Mailing Address - Country:US
Mailing Address - Phone:425-899-5300
Mailing Address - Fax:425-899-5304
Practice Address - Street 1:14048 JUANITA DR NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5312
Practice Address - Country:US
Practice Address - Phone:425-899-5300
Practice Address - Fax:425-899-5304
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP30002524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77955Medicare UPIN