Fackenthall, Joy R
Fackenthall, Joy R is an individual health care provider with primary practice located at 7205 265Th St Nw , Stanwood WA 98292-6221. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Fackenthall, Joy R can be contacted via phone (360) 629-1504.Contact Information
Primary practice address
7205 265Th St Nw
Stanwood WA 98292-6221
Phone: (360) 629-1504
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 37986 | Washington |
Profile Details
| NPI number | 1376626556 |
|---|---|
| LBN Legal business name | Fackenthall, Joy R |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | Dec 11th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376626556 | NPPES |
| Washington | MEDICAID | 1008993 | |
| Washington | Other | 37986 |
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