Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD00033694 | WA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD00033694 | WA |
NPI | 1588698179 |
---|---|
Provider Name | Barbara S Mendrey |
First Address | Bothell, WA 98011-5773 |
Second Address | Bothell, WA 98011-5773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7110687 | (05) | WA |
F43773 | (02) | WA |