Active NPI
Anna Vitalevna Fomin
- Athletic Trainer
- Otis Orchards, WA
National Provider Identifier
1801535588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 5210 N Harvard Rd
Otis Orchards, WA 99027-9282 - Phone
- (509) 475-1551
- NPI assigned
- Jun 1, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
5210 N Harvard Rd
Otis Orchards, WA 99027-9282
Mailing address
5210 N Harvard Rd
Otis Orchards, WA 99027-9282
Phone (509) 475-1551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654041600000",
"number": "1801535588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5210 N HARVARD RD",
"city": "OTIS ORCHARDS",
"state": "WA",
"postal_code": "990279282",
"telephone_number": "509-475-1551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5210 N HARVARD RD",
"city": "OTIS ORCHARDS",
"state": "WA",
"postal_code": "990279282",
"telephone_number": "509-475-1551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOMIN",
"first_name": "ANNA",
"middle_name": "VITALEVNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-01",
"last_updated": "2022-06-01",
"certification_date": "2022-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Otis Orchards, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.