Provider Demographics
NPI:1669434403
Name:NORRIS, MICHAEL NORMAN (ARNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NORMAN
Last Name:NORRIS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:800 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2803
Practice Address - Country:US
Practice Address - Phone:509-458-5800
Practice Address - Fax:509-473-7511
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62899363L00000X
WAAP30005735363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0262276OtherL&I-RADIA REST OF WA
ID1669434403Medicaid
WA0379746OtherL&I-RADIA KING CTY
WA0406800OtherL&I-SEATTLE RADIOLOGY
WA1039535Medicaid