Provider Demographics
NPI:1922636331
Name:MAMIKUNIAN, CONNOR P
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:P
Last Name:MAMIKUNIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 DEXER AVE NORTH
Mailing Address - Street 2:APT 734
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109
Mailing Address - Country:US
Mailing Address - Phone:907-301-6192
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST.
Practice Address - Street 2:A-300 HEALTH SCIENCES CENTER 356340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195
Practice Address - Country:US
Practice Address - Phone:206-543-7212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program