Provider Demographics
NPI:1518456847
Name:NORTH END MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NORTH END MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:NORTH END MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, FNP-BCC
Authorized Official - Phone:360-450-5000
Mailing Address - Street 1:2557 TURNINGLEAF LN
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8622
Mailing Address - Country:US
Mailing Address - Phone:360-632-7366
Mailing Address - Fax:360-720-2812
Practice Address - Street 1:825 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-4210
Practice Address - Country:US
Practice Address - Phone:360-450-5000
Practice Address - Fax:360-450-5051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH END MEDICAL PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30806622363LF0000X
363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty