Provider Demographics
NPI:1124643770
Name:SANCHEZ, MARISOL (PC 60355053)
Entity type:Individual
Prefix:MISS
First Name:MARISOL
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PC 60355053
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MY SELF
Mailing Address - Street 1:8807 EMERSON PL
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-1947
Mailing Address - Country:US
Mailing Address - Phone:206-356-6529
Mailing Address - Fax:
Practice Address - Street 1:8807 EMERSON PL
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-1947
Practice Address - Country:US
Practice Address - Phone:206-356-6529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604605339374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604605339Medicaid
WA60355053OtherMADICARE AND MEDICAID
WA604605339OtherMADICARE AND MEDICAID
WA6035505Medicaid