Provider Sheet - Agent Resource

	A	B	C	D	E	F	G	H	I	J	L	M	N	O	P	Q	R	S	T	U	V	W	X	Y	AA	AC	AE
1	Provider List
2	State	Market	Provider	Able to Assign PCP?	Provider Credential	Provider NPI	Provider Type	Practice	Practice Address	Phone #	Allwell By WellCare	Alignment Health	Amerigroup- TX	Amerigroup- AZ	Anthem- GA	BCBS-AZ	BCBS- MA	BCBS-NC	Cigna	Devoted	Humana	Tufts	United Healthcare	WellCare	Male or Female	Language	Schedule new visits?
3	AZ	Phoenix	Christina Ross	Y	FNP-C	1043684012	TP	Ellsworth	9124 East Main Street, Suites 20-21, Mesa AZ, 85207	480-295-8070			---		---		---	---	82002TIM			---		---	F
4	AZ	Phoenix	Shalena Wright	Y	FNP	1245928563	TP-PGMP	Peoria	6611 W. Peoria Ave., Glendale, AZ, 85302	602-325-5580			---		---		---	---	64169TIM			---		---
5	AZ	Phoenix	Mohammad Dardari	Y	MD	1467405357	TP	Greenway	3202 E. Greenway Rd., Phoenix, AZ, 85032	602-325-5577			---		---		---	---	36540TIM	LX2KY6-AG		---		---
6	AZ	Tucson	Bijan Mossadeghi	Y	MD	1518313881	TP	Broadway	8616 E. Broadway Blvd. Tucson, AZ 85710	520-468-4809	5392074	CCG001AZP060	---	15979173	---	1518313881	---	---	52135TIM	---	259054	---	1518313881	---	M
7	AZ	Tucson	Audrey Gray	Y	PA-C	1083158067	TP	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801	3911654		---	15978902	---	1083158067	---	---	39925TIM	---	259053	---	1083158067	---	F
8	AZ	Tucson	David Smock	Y	MD	1780850214	TP	Broadway	8616 E. Broadway Blvd. Tucson, AZ 85710	520-468-4809		CCG001AZ11780850214	---	15978906	---		---	---	52135TIM	---	259054	---		---	F
9	AZ	Tucson	Tricia Alvarez	Y	NP	1477033900	TP	Pusch View	10515 N Oracle Rd Suite 185, Oro Valley, AZ 85737	520-585-5878			---	15979202	---		---	---	46434TIM	---		---		---
10	AZ	Tucson	Lori Barbula	Y	FNP	1154076412	TP	Broadway	8616 E. Broadway Blvd. Tucson, AZ 85710	520-468-4809	5763357		---		---		---	---	46536TIM	---	259054	---		---	F
11	AZ	Tucson	Rebecca Jones	Y	FNP	1043900491	TP-PGMP	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801			---		---		---	---	46542TIM	---	259053	---		---	F
12	AZ	Tucson	Gabriel Alarcon	Y	DO	1336194695	TP	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801	3267480		---		---		---	---		---		---		---	F
13	AZ	Tucson	Colleen Gumm	Y	NP	1568485951	CTMD	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801	635092		---	15978931	---	1568485951	---	---	44219TIM	---		---	1568485951	---	F
14	AZ	Tucson	John Po	Y	MD	1366638561	DMD	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801	675017	CCG001AZP030	---	15978930	---	1366638561	---	---	34220TIM	---	259053	---	1366638561	---	F
15	AZ	Tucson	Sharon Boyce	Y	MD	1053508838	TP	Broadway	8616 E. Broadway Blvd. Tucson, AZ 85710	520-468-4809	4473515	CCG001AZP027	---	15978888	---	1053508838	---	---	34222TIM	---	259054	---	1053508838	---	F
16	AZ	Tucson	Joy Kiviat	Y	NP	1063814176	TP	Pusch View	10515 N Oracle Rd Suite 185, Oro Valley, AZ 85737	520-585-5878	2251568	CCGMAZ500012	---	15978905	---	1063814176	---	---	44232TIM	---	372709	---	1063814176	---	M
17	AZ	Tucson	Martin DuFour	Y	MD	1578792800	CTMD	Pusch View	10515 N Oracle Rd Suite 185, Oro Valley, AZ 85737	520-585-5878	5689258		---		---		---	---		---		---		---	F
18	AZ	Tucson	Austin Welsh	Y	MD	1083678650	TP	Grant	3902 E. Grant Rd. Tucson, AZ 85712	520-468-4801	620534	CCG001AZP032	---	15979164	---	1083678650	---	---	34332TIM	---		---	1083678650	---	F
19	CO	Colorado	Joshua Solot	Y	DO	1043366727	CTMD	Glendale	4100 E. Mississippi Ave - Suite 110, Glendale, CO 80246	303-552-9522	---	---	---	---	---	---	---	---	QMP000004722250	---	221676	---	1043366727	---	M
20	CO	Colorado	Melissa Beaman	Y	NP	1336139369	TP	Arvada	8175 Sheridan Boulevard - Unit N, Arvada, CO 80003	303-557-0855	---	---	---	---	---	---	---	---	N/A	---	221676	---	1336139369	---	F
21	CO	Colorado	Douglas Golding	Y	MD	1306803143	TP	Lakewood	1692 Wadsworth Boulevard, Lakewood, CO 80214	303-557-9747	---	---	---	---	---	---	---	---		---	221675	---	1306803143	---	F
22	CO	Colorado	Michelle Gravalos	Y	NP	1740652833	TP	Aurora	1080 S Sable Blvd, Aurora, CO 80012	303-552-9577	---	---	---	---	---	---	---	---	N/A	---	263458	---	1740652833		F
23	CO	Colorado	Emily Marsh	Y	MD	1851493613	TP	Glendale	4100 E. Mississippi Ave - Suite 110, Glendale, CO 80246	303-552-9522	---	---	---	---	---	---	---	---	QMP000004737612	---	221676	---	1851493613	---	F
24	CO	Colorado	Jason Barmore	Y	MD	1902933948	TP	Lakewood	1692 Wadsworth Boulevard, Lakewood, CO 80214	303-557-9747	---	---	---	---	---	---	---	---	QMP000004750528	---	221675	---	1902933948	---	M
25	CO	Colorado	Kelly Jeong	Y	MD	1487781431	TP	Arvada	8175 Sheridan Boulevard - Unit N, Arvada, CO 80003	303-557-0855	---	---	---	---	---	---	---	---	QMP000004714070	---	221676	---	1487781431	---	F
26	CO	Colorado	Joseph Ladika	Y	MD	1477534154	CTMD	Littleton	8246 West Bowles Avenue, Bldg 1, Unit T, Littleton, CO 80123	303-800-0880	---	---	---	---	---	---	---	---	QMP000004563983	---	263457	---	1477534154	---	F
27	CO	Colorado	Timothy Eldridge	Y	MD	1447455852	TP	Aurora	1080 S Sable Blvd, Aurora, CO 80012	303-552-9577	---	---	---	---	---	---	---	---	unable to find	---	263458	---	1447455852	---	F
28	CO	Colorado	Kristianna Roberts	Y	DO	1790955185	TP	Arvada	8175 Sheridan Boulevard - Unit N, Arvada, CO 80003	303-557-0855	---	---	---	---	---	---	---	---	QMP000004650571	---	483377	---	1790955185	---	F
29	CO	Colorado	Samuel Jacobowitz	Y	MD	1629427364	TP	Arvada	8175 Sheridan Boulevard - Unit N, Arvada, CO 80003	303-557-0855	---	---	---	---	---	---	---	---	QMP000005075753	---	221676	---	1629427364	---	F
30	CO	Colorado	Leigh Thompson	Y	MD	1215986690	TP	Littleton	8246 West Bowles Avenue, Bldg 1, Unit T, Littleton, CO 80123	303-800-0880	---	---	---	---	---	---	---	---	QMP000005139912	---		---	1215986690	---	F
31	CO	Colorado	Stephanie Cosentino	Y	NP	1659030013	TP	Arvada	8175 Sheridan Boulevard - Unit N, Arvada, CO 80003	303-557-0855	---	---	---	---	---	---	---	---	N/A	---		---	1659030013	---	M
32	CO	Colorado	Jennifer Burke-Krieg	Y	DO	1790070258	CTMD	Littleton	8246 West Bowles Avenue, Bldg 1, Unit T, Littleton, CO 80123	303-800-0880	---	---	---	---	---	---	---	---	QMP000004190406	---	263457	---	1790070258	---	M
33	CO	Colorado	Kerry Hildreth	Y	MD	1982825543	TP	Glendale	4100 E. Mississippi Ave - Suite 110, Glendale, CO 80246	303-552-9522	---	---	---	---	---	---	---	---	MP000004435987	---	221674	---	1982825543	---	F
34	CO	Colorado	Mark Deem	Y	DO	1538273644	TP	Aurora	1080 S Sable Blvd, Aurora, CO 80012	303-552-9577	---	---	---	---	---	---	---	---	QMP000004564259	---	263458	---	1538273644	---	F
35	CO	Colorado	Haleigh Borneman	Y	NP	1285179176	TP	Aurora	1080 S Sable Blvd, Aurora, CO 80012	303-552-9577	---	---	---	---	---	---	---	---	N/A	---		---	1285179176	---	F
36	CO	Colorado	Reade Selcke	Y	NP	1972201317	TP	Lakewood	1692 Wadsworth Boulevard, Lakewood, CO 80214	303-557-9747	---	---	---	---	---	---	---	---	N/A	---	221675	---	1972201317	---	F
37	CO	Colorado	Emily Yebra	Y	NP	1033817077	TP	Glendale	4100 E. Mississippi Ave - Suite 110, Glendale, CO 80246	303-552-9522	---	---	---	---	---	---	---	---	N/A	---	221674	---	1033817077	---	F
38	CO	Colorado	Ashley Woodworth	Y	DO	1962964221	TP	Lakewood	1692 Wadsworth Boulevard, Lakewood, CO 80214	303-557-9747	---	---	---	---	---	---	---	---		---		---		---	F
39	GA	Georgia	Casey Henritz	Y	DO	1710113568	CTMD	Belvedere	3527 Memorial Dr., Unit W Decatur, GA 30032	404-573-4844	---	---	---	---		---	---	---		---		---	1710113568	2649767	F
40	GA	Georgia	Shangeetha Balakumar	Y	MD	1720116452	TP	Marietta	280 Cobb Pkwy. SE, Suite 60 Marietta GA 30060	678-820-7373	---	---	---	---	14825587	---	---	---	QMP000004746421	---	627422	---	1720116452	2643398	F
41	GA	Georgia	Alexis Atwater	Y	MD	1922328830	CTMD	Belvedere	3527 Memorial Dr., Unit W Decatur, GA 30032	404-573-4844	---	---	---	---	13015550	---	---	---	QMP000004746442	---	376866	---	1922328830	2643385	F
42	GA	Georgia	Patricia Kelly	Y	MD	1801968755	TP	Marietta	280 Cobb Pkwy. SE, Suite 60 Marietta GA 30060	678-820-7373	---	---	---	---	14793679	---	---	---	QMP000004425173	---	376867	---	1801968755	2646169
43	GA	Georgia	Zahid Afridi	Y	MD	1649347683	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---	13307697	---	---	---	QMP000003449869	---		---	1649347683		F
44	GA	Georgia	Josue Flores Balderas	Y	MD	1831621986	TP	Sugarloaf	4850 Sugarloaf Pkwy., Suite 101 Lawrenceville, GA 30044	678-490-8300	---	---	---	---	13105972	---	---	---	QMP000004730157	---	376865	---	1831621986	2646402
45	GA	Georgia	Tracey Anyanwu	Y	DO	1487190526	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---	13039563	---	---	---	QMP000004414736	---	634017	---	1487190526	2643416
46	GA	Georgia	Shruti Patel	Y	MD	1952746133	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---	14821398	---	---	---	QMP000004790901	---	376867	---	1952746133	2647309
47	GA	Georgia	Priya Schaffner	Y	NP	1942893235	TP	Belvedere	3527 Memorial Dr., Unit W Decatur, GA 30032	404-573-4844	---	---	---	---		---	---	---	QMP000004810743	---	376866	---	1942893235	2647359
48	GA	Georgia	Phyllis Dowden	Y	NP	1497992598	TP	Metropolitan	2685 Metropolitan Pkwy. SW, Suite G Atlanta, GA 30315	404-596-4344	---	---	---	---		---	---	---	QMP000004721752	---	634017	---	1497992598	2647610
49	GA	Georgia	LaWanda Martindale	Y	NP	1346699188	TP	Metropolitan	2685 Metropolitan Pkwy. SW, Suite G Atlanta, GA 30315	404-596-4344	---	---	---	---		---	---	---	QMP000004511004	---		---	1346699188	2648605
50	GA	Georgia	Hariharan Athreya	Y	MD	1851898522	TP	Metropolitan	2685 Metropolitan Pkwy. SW, Suite G Atlanta, GA 30315	404-596-4344	---	---	---	---		---	---	---	QMP000005000104	---		---	1851898522	2651337
51	GA	Georgia	Tracey Anyanwu	Y	DO	1487190526	TP	Metropolitan	2685 Metropolitan Pkwy. SW, Suite G Atlanta, GA 30315	404-596-4344	---	---	---	---		---	---	---	QMP000004414736	---	634017	---	1487190526
52	GA	Georgia	Patricia Kelly	Y	MD	1801968755	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---	14793679	---	---	---	QMP000004425173	---	376867	---	1801968755	2646169
53	GA	Georgia	Danielle Timmons	Y	DO	1841723509	TP	Belvedere	3527 Memorial Dr., Unit W Decatur, GA 30032	404-573-4844	---	---	---	---	14825731	---	---	---	QMP000005007059	---	376866	---	1841723509	2789922
54	GA	Georgia	Leonardo Cordero	Y	NP	1902303225	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---		---	---	---	QMP000005005771	---	376867	---	1902303225	3234929
55	GA	Georgia	Mona Blackwell	Y	NP	1811659535	TP	Sugarloaf	4850 Sugarloaf Pkwy., Suite 101 Lawrenceville, GA 30044	678-490-8300	---	---	---	---		---	---	---	QMP000005066999	---	376865	---		3254504
56	GA	Georgia	Laura Elliott	Y	NP	1063022481	TP	Shiloh Square	3895 Cherokee St. NW #400 Kennesaw, GA 30144	678-369-7755	---	---	---	---		---	---	---	QMP000005052721	---		---		3254649
57	GA	Georgia	Modupeola Brisibe	Y	NP	1376993519	TP	Marietta	280 Cobb Pkwy. SE, Suite 60 Marietta GA 30060	678-820-7373	---	---	---	---		---	---	---	QMP000005052733	---	627422	---			F
58	GA	Georgia	Amber Orquia	Y	MD	1881683001	TP	Mableton	5015 Floyd Rd., Suite 170 Mableton, GA 30126	678-695-6989	---	---	---	---		---	---	---	QMP000004259132	---	627507	---		2860476	F
59	GA	Georgia	Bhavika Patel	Y	MD	1770920258	TP	Shiloh Square	3895 Cherokee St. NW #400 Kennesaw, GA 30144	678-369-7755	---	---	---	---	15256202	---	---	---	QMP000004148899	---	627431	---	1770920258	3191956	F
60	GA	Georgia	Madhav Patel	Y	MD	1679079685	TP	Marietta	280 Cobb Pkwy. SE, Suite 60 Marietta GA 30060	678-820-7373	---	---	---	---		---	---	---	QMP000005435950	---		---	1679079685	3238647	F
61	GA	Georgia	Ania Rodney	Y	MD	1679968440	TP	Mableton	5015 Floyd Rd., Suite 170 Mableton, GA 30126	678-695-6989	---	---	---	---		---	---	---	QMP000004575244	---	627507	---	1679968440	2643416	M
62	GA	Georgia	Nicole Treadway	Y	MD	1306305685	TP	Belvedere	3527 Memorial Dr., Unit W Decatur, GA 30032	404-573-4844	---	---	---	---	14822438	---	---	---	QMP000005435952	---	376866	---		2643385	M
63	GA	Georgia	Jensil Daniel	Y	DO	1609295765	TP	Tucker	4424 Hugh Howell Rd., Suite D Tucker, GA 30084	404-692-4466	---	---	---	---	15070579	---	---	---	QMP000005121011	---	376867	---		2643398
64	GA	Georgia	Puja Mangukiya	Y	MD	1265919328	TP	Sugarloaf	4850 Sugarloaf Pkwy., Suite 101 Lawrenceville, GA 30044	678-490-8300	---	---	---	---	14797777	---	---	---	QMP000005518658	---	376865	---		3274328
65	MA	Northeast	Sharon Mahoney	Y	MD	1205974722	CTMD	Hyannis	1070 Iyannough Road Hyannis MA 02601	508-948-3400	---	---	---	---	---	---	700J08612	---	---	---	---	1205974722	1205974722	---
66	MA	Northeast	Jane Craig	Y	MD	1952461402	TP	Hyannis	1070 Iyannough Road Hyannis MA 02601	508-948-3400	---	---	---	---	---	---	700J42097	---	---	---	---	1952461402	1952461402	---
67	MA	Northeast	Andrew Flewwelling	Y	MD	1396717468	TP	Hyannis	1070 Iyannough Road Hyannis MA 02601	508-948-3400	---	---	---	---	---	---	700J29714	---	---	---	---	1396717468	1396717468	---
68	MA	Northeast	Kalpna Thuraisamy	Y	DO	1245315290	TP	Hyannis	1070 Iyannough Road Hyannis MA 02601	508-948-3400	---	---	---	---	---	---	700J46793	---	---	---	---	1245315290	1245315290	---	F
69	MA	Northeast	Mary-Amanda Wojtyk O'Neill	Y	MD	1548550882	TP	Hyannis	1070 Iyannough Road Hyannis MA 02601	508-948-3400	---	---	---	---	---	---	700J55686	---	---	---	---	1548550882	1548550882	---	M
70	NC	Charlotte	Melanie McMinn	Y	MD	1366617029		Pineville	8332 Pineville Matthews Rd., Suite 205 Charlotte, NC 28226	704-414-2244	---	---	---	---	---	---	---	1366617029	QMP000004710457	---	638052	---	1366617029	2646169	F
71	NC	Charlotte	Danielle Newman (formally Rosen)	Y	MD	1891178190		MoRa	4014 Connection Point Blvd., Suite C Charlotte, NC 28212	704-343-8282	---	---	---	---	---	---	---	1891178190		---	639095	---	1891178190	2647610	M
72	NC	Charlotte	Jenny Griffin	Y	DO	1336282011		Pineville	8332 Pineville Matthews Rd., Suite 205 Charlotte, NC 28226	704-414-2244	---	---	---	---	---	---	---	1336282011	QMP000004710477	---	639096	---	1336282011	2648605	F
73	NC	Triad	Liliana Pantea	Y	MD	1124135397		Winston Salem	3274 Silas Creek Pkwy., Winston Salem, NC 27103	336-604-2822	---	---	---	---	---	---	---	1124135397	QMP000004781529	---	639099	---	1124135397	2647309	M
74	NC	Charlotte	Sara Movaghar	Y	DO	1114311966		MoRa	4014 Connection Point Blvd., Suite C Charlotte, NC 28212	704-343-8282	---	---	---	---	---	---	---	1114311966	QMP000004931081	---	639095	---	1114311966	2647359	F
75	NC	Triad	Sydney Clark	Y	MD	1669868956		High Point	274 Eastchester Dr., Suite 120 High Point, NC 27262	336-542-2992	---	---	---	---	---	---	---	1669868956	QMP000004902152	---	639096	---	1669868956	2789922	M
76	NC	Charlotte	Dana Chopra	Y	MD	1194189183		Pineville	8332 Pineville Matthews Rd., Suite 205 Charlotte, NC 28226	704-414-2244	---	---	---	---	---	---	---	1194189183	QMP000004716500	---	638052	---	1194189183		M
77	NC	Triad	Mahitha Reddy	Y	MD	1619321007		Greensboro	3351 Battleground Ave. ,Greensboro, NC 27410	336-645-7900	---	---	---	---	---	---	---	1619321007	QMP000005342715	---	639103	---	1619321007		F
78	NC	Triad	Allison Combs	Y	DO	1861852196		Winston Salem	3274 Silas Creek Pkwy., Winston Salem, NC 27103	336-604-2822	---	---	---	---	---	---	---		QMP000005438568	---	639099	---	1861852196		M
79	NC	Triad	Ashley Corbett	Y	NP	1063990869		Greensboro	3351 Battleground Ave. ,Greensboro, NC 27410	336-645-7900	---	---	---	---	---	---	---			---		---	1063990869		F
80	NC	Triad	Beverly Yercheck	Y	NP	1902156128		High Point	274 Eastchester Dr., Suite 120 High Point, NC 27262	336-542-2992	---	---	---	---	---	---	---			---		---	1902156128	---	F
81	NH	Northeast	Erin Storm	Y	PA-C	1891232401	TP	One Medical at Dartmouth	7 Allen St. Hanove NH 03755	603-738-1164	---	---	---	---	---	---	---	---	---	---	405240	---	1891232401	---	M
82	TX	Texas	Sarah Candler	Y	MD	1659614352		Northside	4414 North Freeway, Suite 300 Houston, TX 77022	713-589-8643	---	---	14389717	---	---	---	---	---	QMP000004018136	LX28AE-AA	629699	---	---	2601206	F
83	TX	Texas	Grace Varas	Y	DO	1295958627		Cy-Fair	12266 Farm to Market 1960 Rd. West Houston, TX 77065	281-720-8998	---	---	14555858	---	---	---	---	---	C08614034	LX3ECS-AC	629704	---	---	2602376	M
84	TX	Texas	Seema Chokshi	Y	MD	1588893598		Four Corners	9440A Hwy 6 South Houston, TX 77083	281-408-4488	---	---	14375985	---	---	---	---	---	QMP000004703402	LX38SU-AD	629705	---	---	2602272	M
85	TX	Texas	Elenita Rosado	Y	MD	1144403486		Forest West	5323 Antoine Dr. Houston, TX 77091	713-493-6437	---	---	1144403486	---	---	---	---	---	QMP000003757699	LX28C7-AA	629701	---	---	2602186
86	TX	Texas	Christina Rohren	Y	MD	1659722775		Braeburn	6613 S. Braeswood Blvd. Houston, TX 77096	713-491-4787	---	---	14388932	---	---	---	---	---	QMP000004375046	LX28C2-AF	629698	---	---	2664228
87	TX	Texas	Jairo Bermudez	Y	MD	1578550919		Forest West	5323 Antoine Dr. Houston, TX 77091	713-493-6437	---	---	14390841	---	---	---	---	---	QMP000003950561	LX2JG2-AE		---	---	2764908
88	TX	Texas	Sree latha Ramphul	Y	DO	1821436403		Braeburn	6613 S. Braeswood Blvd. Houston, TX 77096	713-491-4787	---	---	14211966	---	---	---	---	---	QMP000004414353	LX28C2-AG	629698	---	---	2770666
89	TX	Texas	Oluwakemi Osholake	Y	MD	1174044796		Spring Branch	10124 Hammerly Blvd. Houston, TX 77080	713-335-0623	---	---	1174044796	---	---	---	---	---	QMP000004756857	LX28C7-AC	629701	---	---	3022209
90	TX	Texas	Jairo Bermudez	Y	MD	1578550919		Northside	4414 North Freeway, Suite 300 Houston, TX 77022	713-589-8643	---	---	14390841	---	---	---	---	---	QMP000003950561	LX2JG2-AE		---	---	2764908
91	TX	Texas	Jasjit Singh	Y	MD	1932589421		Cy-Fair	12266 Farm to Market 1960 Rd. West Houston, TX 77065	281-720-8998	---	---		---	---	---	---	---	QMP000005170719	LX28AG-AH	629704	---	---	2972367
92	WA	Washington	Margaret Adam	Y	MD	1700812237	CTMD	Federal Way	1414 S 324th Street Suite B207, Federal Way, WA 98003	253-220-3121	---	---	---	---	---	---	---	---	---	---	266928	---	1700812237	2921580
93	WA	Washington	Mimi Ngoc Nguyen	Y	MD	1063754075	TP - PRN	Shoreline	15214 Aurora Ave N, Shoreline, WA 98133	206-518-9021	---	---	---	---	---	---	---	---	---	---	348724	---	1063754075	2919679
94	WA	Washington	Beth Fricke	Y	MD	1417342593	TP	Shoreline	15214 Aurora Ave N, Shoreline, WA 98133	206-518-9021	---	---	---	---	---	---	---	---	---	---	259052	---	1417342593	2919505	M
95	WA	Washington	Christopher Peoples	Y	MD	1205198959	CTMD	Central Tacoma	5006 Center Street Suite R, Tacoma, WA, 98409	253-275-0200	---	---	---	---	---	---	---	---	---	---	378797	---	1205198959	2919469	F
96	WA	Washington	Jeremia Bernhardt	Y	MD	1073738373	CTMD	Renton	64 Rainier Ave S, Renton, WA 98057	425-224-2144	---	---	---	---	---	---	---	---	---	---	259048	---	1073738373	2921629	F
97	WA	Washington	Stephanie Wiman	Y	MD	1932531779	CTMD	Puyallup	3705 S. Meridian Ave., Suite B, Puyallup, WA 98373	253-765-5050	---	---	---	---	---	---	---	---	---	---	378798	---	1932531779	2921649	F
98	WA	Washington	Jeremy Oulton	Y	MD	1801327366	TP	Federal Way	1414 S 324th Street Suite B207, Federal Way, WA 98003	253-220-3121	---	---	---	---	---	---	---	---	---	---	266928	---	1801327366	3034994	M
99	WA	Washington	Maren Zaro	Y	NP	1841739745	TP	Central Tacoma	5006 Center Street Suite R, Tacoma, WA, 98409	253-275-0200	---	---	---	---	---	---	---	---	---	---	378797	---	1841739745	2956223	M
100	WA	Washington	Shannon Waterman	Y	MD	1649279860	TP	Renton	64 Rainier Ave S, Renton, WA 98057	425-224-2144	---	---	---	---	---	---	---	---	---	---	259048	---	1649279860	3021527	M