Provider Demographics
NPI:1720306780
Name:FACTORIA WOMEN & FAMILY CLINIC
Entity Type:Organization
Organization Name:FACTORIA WOMEN & FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GAYLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-644-2273
Mailing Address - Street 1:4140 FACTORIA BLVD SE STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5261
Mailing Address - Country:US
Mailing Address - Phone:425-644-2273
Mailing Address - Fax:
Practice Address - Street 1:4140 FACTORIA BLVD SE STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5261
Practice Address - Country:US
Practice Address - Phone:425-644-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005075261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30005075OtherLICENSE