Provider Demographics
NPI:1942967393
Name:ALDERWOOD ANKLE & FOOT CLINIC P.S.
Entity Type:Organization
Organization Name:ALDERWOOD ANKLE & FOOT CLINIC P.S.
Other - Org Name:LAKE STEVENS ANKLE AND FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOPHINA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-778-5666
Mailing Address - Street 1:9514 4TH ST NE UNIT 201
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1937
Mailing Address - Country:US
Mailing Address - Phone:425-397-7401
Mailing Address - Fax:425-397-7627
Practice Address - Street 1:9514 4TH ST NE UNIT 201
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1937
Practice Address - Country:US
Practice Address - Phone:425-397-7401
Practice Address - Fax:425-397-7627
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALDERWOOD ANKLE AND FOOT CLINIC, P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty