Provider Demographics
NPI: | 1780053793 |
---|---|
Name: | TURNER, ARIEL (PA-C) |
Entity type: | Individual |
Prefix: | |
First Name: | ARIEL |
Middle Name: | |
Last Name: | TURNER |
Suffix: | |
Gender: | F |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2979 SQUALICUM PKWY STE 203 |
Mailing Address - Street 2: | |
Mailing Address - City: | BELLINGHAM |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98225-1813 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-733-7670 |
Mailing Address - Fax: | 360-647-1901 |
Practice Address - Street 1: | 2979 SQUALICUM PKWY STE 203 |
Practice Address - Street 2: | |
Practice Address - City: | BELLINGHAM |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98225-1813 |
Practice Address - Country: | US |
Practice Address - Phone: | 360-733-7670 |
Practice Address - Fax: | 360-647-1901 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2015-09-20 |
Last Update Date: | 2022-08-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 60698227 | 363A00000X |
WA | PA60698227 | 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 2075187 | Medicaid |