Provider Demographics
NPI:1215915723
Name:NEUBAUER, NANCY JANE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JANE
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:PROVIDENCE EVERETT MEDICAL CENTER
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98206
Practice Address - Country:US
Practice Address - Phone:425-261-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000386132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA135541OtherL&I PROVIDER NUMBER
WA135540OtherL&I PROVIDER NUMBER
WA174096OtherL&I PROVIDER NUMBER
WA8210130Medicaid
WAP00359926OtherRR MEDICARE
WAAB15102Medicare ID - Type UnspecifiedPROVIDER NUMBER
WA135541OtherL&I PROVIDER NUMBER
WA8210130Medicaid
WAG16631Medicare UPIN
WAAB15103Medicare ID - Type UnspecifiedPROVIDER NUMBER