Provider Demographics
NPI:1528051893
Name:ISHAQUE, PHIROCE (ARNP)
Entity type:Individual
Prefix:
First Name:PHIROCE
Middle Name:
Last Name:ISHAQUE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98886
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-8886
Mailing Address - Country:US
Mailing Address - Phone:253-589-6484
Mailing Address - Fax:253-984-1079
Practice Address - Street 1:4901 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-589-6484
Practice Address - Fax:253-984-1079
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 30006491363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638206Medicaid
WAP00081924OtherRR MEDICARE
WA0177954OtherL&I
WA9638206Medicaid
WAP00081924OtherRR MEDICARE