Provider Demographics
NPI:1912418914
Name:EAGLE HARBOR FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:EAGLE HARBOR FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-626-3133
Mailing Address - Street 1:600 WINSLOW WAY E STE 114
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3252
Mailing Address - Country:US
Mailing Address - Phone:206-842-5979
Mailing Address - Fax:206-842-4124
Practice Address - Street 1:600 WINSLOW WAY E STE 114
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3252
Practice Address - Country:US
Practice Address - Phone:206-842-5979
Practice Address - Fax:206-842-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP20004070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty