Provider Demographics
NPI:1558374884
Name:PRIMARY CARE SEQUIM PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE SEQUIM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ARNP
Authorized Official - Phone:360-582-1200
Mailing Address - Street 1:520 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3079
Mailing Address - Country:US
Mailing Address - Phone:360-582-1200
Mailing Address - Fax:360-582-1230
Practice Address - Street 1:520 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-582-1200
Practice Address - Fax:360-582-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1780625400OtherINDIVIDUAL NPI
WAP65100Medicare UPIN