Provider Demographics
NPI:1811167620
Name:NORTHSHORE FAMILY PRACTICE PLLC
Entity type:Organization
Organization Name:NORTHSHORE FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MENDREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-424-2100
Mailing Address - Street 1:12900 NE 180TH ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5773
Mailing Address - Country:US
Mailing Address - Phone:425-424-2100
Mailing Address - Fax:
Practice Address - Street 1:12900 NE 180TH ST
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5773
Practice Address - Country:US
Practice Address - Phone:425-424-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033694207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF43773Medicare PIN