Wallace, Kent William

Wallace, Kent William is an individual health care provider with primary practice located at 1321 Colby Ave Medical Staff Office (Pmg), Everett WA 98201-1665. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Wallace, Kent William can be contacted via phone (425) 261-2000.

Contact Information

Primary practice address
1321 Colby Ave Medical Staff Office (Pmg) Everett WA 98201-1665
Phone: (425) 261-2000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA10000442 Washington

Profile Details

NPI number 1770662835
LBN Legal business name Wallace, Kent William
Credentials PA-C, ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2006
Last updated Feb 6th, 2015 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770662835 NPPES
Washington Other 124775 LABOR AND INDUSTRIES
Washington Other WA6512 LABOR AND INDUSTRIES
Washington Other 8803430 LABOR AND INDUSTRIES

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