Provider Demographics
NPI:1134842693
Name:VACCARO, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:VACCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 3RD AVE W STE 107
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-1997
Mailing Address - Country:US
Mailing Address - Phone:360-262-1160
Mailing Address - Fax:
Practice Address - Street 1:2003 D ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3204
Practice Address - Country:US
Practice Address - Phone:360-262-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program