Provider Demographics
NPI:1871678748
Name:CARNEY, NICOLE SECHRIST (DPM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SECHRIST
Last Name:CARNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 LILLY RD NE
Mailing Address - Street 2:BLDG 1
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5255
Mailing Address - Country:US
Mailing Address - Phone:360-438-9092
Mailing Address - Fax:360-438-3906
Practice Address - Street 1:520 LILLY RD NE
Practice Address - Street 2:BLDG 1
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5255
Practice Address - Country:US
Practice Address - Phone:360-438-9092
Practice Address - Fax:360-438-3906
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO6YO213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACA2730OtherREGENCE RIDER
WA1109560Medicaid
WA1181670001Medicare NSC
WACA2730OtherREGENCE RIDER