Provider Demographics
NPI:1689787277
Name:DIABETES MANAGEMENT NORTHWEST PS
Entity Type:Organization
Organization Name:DIABETES MANAGEMENT NORTHWEST PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:KITTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-435-5365
Mailing Address - Street 1:540 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1251
Mailing Address - Country:US
Mailing Address - Phone:360-435-5365
Mailing Address - Fax:360-474-1394
Practice Address - Street 1:540 N WEST AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1251
Practice Address - Country:US
Practice Address - Phone:360-435-5365
Practice Address - Fax:360-474-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00050644173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty