Provider Demographics
NPI:1588814669
Name:CHIBAMBO, HEATHER D (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:CHIBAMBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:SCHOUWEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:7203 129TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:NEWCASTLE
Practice Address - State:WA
Practice Address - Zip Code:98056-1412
Practice Address - Country:US
Practice Address - Phone:425-656-5406
Practice Address - Fax:425-656-5040
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60028910207Q00000X
WAMD.MD.60261626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine