Provider Demographics
NPI:1891456281
Name:ENDOMED FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:ENDOMED FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:253-282-6852
Mailing Address - Street 1:21805 55TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3209
Mailing Address - Country:US
Mailing Address - Phone:253-282-6852
Mailing Address - Fax:
Practice Address - Street 1:5017 196TH ST SW STE 204
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6123
Practice Address - Country:US
Practice Address - Phone:206-424-2911
Practice Address - Fax:206-656-9329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty