| Senior Doc Wa PC | |
|
912 State Ave Marysville WA 98270-4239 | |
| (855) 434-7763 | |
| (949) 281-5550 |
| Full Name | Senior Doc Wa PC |
|---|---|
| Speciality | Family Medicine |
| Location | 912 State Ave, Marysville, Washington |
| Authorized Official Name and Position | Angelica Soto (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 7147025145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Senior Doc Wa PC 5 Hutton Centre Dr Ste 950 Santa Ana CA 92707-8744 Ph: (855) 434-7763 | Senior Doc Wa PC 912 State Ave Marysville WA 98270-4239 Ph: (855) 434-7763 |
| NPI Number | 1588430367 |
|---|---|
| Provider Enumeration Date | 12/01/2023 |
| Last Update Date | 09/11/2025 |
| Certification Date | 09/11/2025 |
| Medicare PECOS PAC ID | 4385087337 |
|---|---|
| Medicare Enrollment ID | O20250212002348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588430367 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Bernadette N Kimemia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689148090 PECOS PAC ID: 0648511063 Enrollment ID: I20190412001550 |
| Provider Name | Henriette Solyst Hvingelby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942353107 PECOS PAC ID: 2668570979 Enrollment ID: I20200605001029 |
| Provider Name | Meredith Alexandra Bock |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1447612940 PECOS PAC ID: 8729339908 Enrollment ID: I20240523001507 |
| Provider Name | Jeffrey John Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932337136 PECOS PAC ID: 7315101003 Enrollment ID: I20241009001526 |
| Provider Name | Anthony Marcus Yniguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871185686 PECOS PAC ID: 2769882331 Enrollment ID: I20241230002681 |
| Provider Name | Christina Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790499218 PECOS PAC ID: 1759753098 Enrollment ID: I20250114002993 |
| Provider Name | Alexi Yarashevich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306340831 PECOS PAC ID: 6406119304 Enrollment ID: I20250116000540 |
| Provider Name | Daniel John Konchan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356047542 PECOS PAC ID: 9931572302 Enrollment ID: I20250127000278 |
| Provider Name | John Geiss |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1053651497 PECOS PAC ID: 5890933071 Enrollment ID: I20250212002408 |
| Provider Name | Sarah Kelley Lockwood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972193217 PECOS PAC ID: 1052725249 Enrollment ID: I20250612003497 |
| Provider Name | Larissa Luu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750940714 PECOS PAC ID: 8123355849 Enrollment ID: I20250716001099 |
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