South Whidbey Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00020537 Issued in WA

Legal business name

SOUTH WHIDBEY PEDIATRICS

Practice address

1690 Layton Rd
Freeland, WA 98249-9456

Phone

(360) 331-1314

NPI assigned

Jun 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Susan Wagner

Title

Office Manager

Phone

(360) 331-1314

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275609600000",
    "number": "1194045708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "98249",
            "telephone_number": "360-331-1314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 LAYTON RD",
            "city": "FREELAND",
            "state": "WA",
            "postal_code": "982499456",
            "telephone_number": "360-331-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH WHIDBEY PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2010-06-04",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-331-1314"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00020537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7090517",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Banchegize Lucy Ann Shelley
• Gwen G. Sipes, LMT, LMP, LMHCA
• Kevin Michael Smith, DC
• Nikki Lee Snyder, L.M.P.
• Margaret Ann Sorrel, D.O.
• Sari Spieler, LMP
• Sally Katherine Stansfield, M.D.
• Steven W. Musto, M.D., PLLC
• Elisa Stone
• Susan J Jones, Arnp MSN PLLC

• Pediatrics Physician in Freeland, WA
• Providers in Freeland, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.