Basic Information
| Provider Information | |||||||||
| NPI: | 1720063902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FECHNER | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | YVONNE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 SAND POIN WAY NE | ||||||||
| Address2: | M/S A5902 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981050371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069875037 | ||||||||
| FaxNumber: | 2069872720 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POIN WAY NE | ||||||||
| Address2: | M/S A5902 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981050371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069875037 | ||||||||
| FaxNumber: | 2069872720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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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 | 2080P0205X | G63045 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 00G630450 | 05 | CA | MEDICAID |