Basic Information
| Provider Information | |||||||||
| NPI: | 1063490282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FROMHART | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 S 336TH ST | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538386180 | ||||||||
| FaxNumber: | 2538386418 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 SOUTH J STREET | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534266660 | ||||||||
| FaxNumber: | 2534266250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 11/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10003451 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 797FR | 01 | WA | REGENCE | OTHER | 8323792 | 05 | WA | MEDICAID | 2268FR | 01 | WA | BSWA | OTHER | 1186FR | 01 | WA | BSWA | OTHER | 0185008 | 01 | WA | LIWA | OTHER | 0215350 | 01 | WA | LIWA | OTHER | 157224 | 01 | WA | LABOR & INDUSTRIES | OTHER | 7066277 | 01 | WA | DSHS | OTHER |