Basic Information
| Provider Information | |||||||||
| NPI: | 1588814669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIBAMBO | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHOUWEILER | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 34876 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565412 | ||||||||
| FaxNumber: | 4256564096 | ||||||||
| Practice Location | |||||||||
| Address1: | 7203 129TH AVE SE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | NEWCASTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980561412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565406 | ||||||||
| FaxNumber: | 4256565040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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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 | 207Q00000X | ML60028910 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD.MD.60261626 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.