GEOFFREY OWEN MCNICOLL (NPI# 1255438586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255438586 |
| Entity Type | Individual |
| Full Name | GEOFFREY OWEN MCNICOLL |
| Credential | M.D. |
| Practice Address |
15214 Canyon Rd E Ste 100 Puyallup WA 98375-7472 |
| Practice Telephone | 2535394200 |
| Practice Fax Number | 2535396005 |
| Mailing Telephone | 2535394200 |
| Mailing Fax Number | 2535396005 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-03-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD60180279 | WA | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | EC081117 | ME | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | STATE L&I | 0273458 | 01 |
| WA | STATE L&I | 0273460 | 01 |
| Street Address |
15214 CANYON RD E STE 100 |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98375-7472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124034723 | Marjorie A Bergsma | Physician Assistant | 15214 Canyon Rd E, Ste 100, Puyallup, WA 98375-7472 | 2006-08-01 |
| 1023667052 | Vicky Lee | Nurse Practitioner | 15214 Canyon Rd E, Puyallup, WA 98375-7457 | 2019-09-11 |
| 1962921767 | Sherri Lynne Hall | Dietitian, Registered | 15214 Canyon Rd E, Puyallup, WA 98375-7472 | 2017-09-12 |
| 1639609159 | Yolanda Lacher Bradford Rodriguez | Nurse Practitioner | 15214 Canyon Rd E, Puyallup, WA 98375 | 2017-06-18 |
| 1982038063 | Gregory Bryant Proulx | Nurse Practitioner | 15214 Canyon Rd E, Ste 120, Puyallup, WA 98375-7472 | 2013-08-26 |
| 1508107087 | Debra Ann Berger | Nurse Practitioner | 15214 Canyon Rd E, Puyallup, WA 98375-7472 | 2013-03-08 |
| 1952646424 | Marvin Paleracio Tolentino | Nurse Practitioner | 15214 Canyon Rd E, Puyallup, WA 98375-7472 | 2012-12-10 |
| 1285979351 | Kimberly Wing-wah Chu | Registered Nurse | 15214 Canyon Rd E, Puyallup, WA 98375-7472 | 2012-11-30 |
| 1184992091 | Emily Katherine Ann Turnbull | Registered Nurse | 15214 Canyon Rd E, Puyallup, WA 98375-7472 | 2011-12-06 |
| 1326357260 | Anna Kali Worden | Nurse Practitioner | 15214 Canyon Rd E, Ste 100, Puyallup, WA 98375-7472 | 2010-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673817 | Cheryl Dann | Registered Nurse | 7224 Pacific Highway E, Milton, WA 98375 | 2019-11-07 |
| 1326554601 | Jasmanpreet Kaur Sidhu | Nurse's Aide | 17003 83rd Ave Cte, Puyallup, WA 98375 | 2017-12-21 |
| 1295257137 | Rafael Martin Morones IIi | Registered Nurse | 17802 87th Ave E, Puyallup, WA 98375 | 2017-07-12 |
| 1467990556 | Tessa D Parker | Massage Therapist | 17528 Meridian E Suite 207, Puyallup, WA 98375 | 2017-02-08 |
| 1144674326 | June Park | Social Worker | 9414 185th Street Ct E, Puyallup, WA 98375 | 2016-04-14 |
| 1417384348 | Washington Dental Corporation, PC | Dentist | 16810 Meridian East Suite J107, Puyallup, WA 98375 | 2013-10-10 |
| 1861825663 | L&t Chinese Medicine LLC | Acupuncturist | 16515 Meridian E., Ste. 200b, Puyallup, WA 98375 | 2013-08-15 |
| 1508110081 | Jennifer Gillings | Speech-Language Pathologist | 17418 74th Ave E, Puyallup, WA 98375 | 2012-11-05 |
| 1275887267 | Andrew Nelson Smith | Pharmacist | 14308 Meridian Ave E., Puyallup, WA 98375 | 2012-10-30 |
| 1538440714 | Zorawar Singh | Dentist | 16810 Meridian E Suite J107, Puyallup, CA 98375 | 2011-09-01 |
| Find all providers in zip 98375 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225584683 | Paladina Health, LLC | Family Medicine | 615 E Pioneer, Suite 103, Puyallup, WA 98372-3317 | 2016-08-26 |
| 1588048862 | Chelsi Goodman | Family Medicine | 1322 3rd St Se Ste 300, Puyallup, WA 98372 | 2015-07-16 |
| 1366824914 | Cris Perez | Family Medicine | 1322 3rd St Se Ste 302, Puyallup, WA 98372-3771 | 2015-06-19 |
| 1891042958 | Noor Azreen Ali | Family Medicine | 15214 Canyon Rd E Ste 100, Puyallup, WA 98375-7472 | 2012-08-08 |
| 1265655070 | Douglas Allan Badzik | Family Medicine | 8919 119th Street Ct E, Puyallup, WA 98373-7976 | 2007-04-10 |
| 1912055286 | Sea-mar Community Health Center | Family Medicine | 10217 125th Street Ct E Fl 2, Puyallup, WA 98374-2761 | 2007-01-05 |
| 1083788160 | John N Daniel | Family Medicine | 801 E Main Street, Puyallup, WA 98372-3365 | 2006-11-20 |
| 1053403634 | Mark S. Kim | Family Medicine | 1803 S Meridian, Puyallup, WA 98371 | 2006-09-29 |
| 1518079722 | Bruce K. Baker | Family Medicine | 1408 3rd St Se Ste 200, Puyallup, WA 98372 | 2006-09-01 |
| 1508881228 | Linh Trang Huynh | Family Medicine | 10116 116th St E, Suite 101, Puyallup, WA 98373-3543 | 2006-07-13 |
| Find all providers in PUYALLUP | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.