DIABETES MANAGEMENT NORTHWEST, P.S.

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Company Details

Legal Name:

Jurisdiction:

WASHINGTON

Entity Type:

WA PROFESSIONAL SERVICE CORPORATION

Category:

DOMESTIC ENTITY

Status:

Inactive

Formation/ Registration Date:

September 7th 2005

Date of Dissolution:

January 3rd 2012

Expiration date:

30 Sep 2011

UBI Number:

602 537 168

ZIP code:

98223

City:

Arlington

County:

SNOHOMISH

Home State:

WASHINGTON

Principal Office Street Address:

540 WEST AVENUE, ARLINGTON, WA, 98223, UNITED STATES

Registered Agent Information

Name	Role	Address
DAVID E DUSKIN	Registered Agent	22422 SR 9 NE, ARLINGTON, WA, 98223, UNITED STATES

Name

Role

Address

DAVID E DUSKIN

Registered Agent

22422 SR 9 NE, ARLINGTON, WA, 98223, UNITED STATES

Key Officers & Management

Name	Role
CHELSEA JOHNSON	Governing Person
DALE DUSKIN	Governing Person
CORY DUSKIN	Governing Person

Name

Role

CHELSEA JOHNSON

Governing Person

DALE DUSKIN

Governing Person

CORY DUSKIN

Governing Person

National Provider Identifier

NPI Number:

1689787277

Link:

View on NPI website

Authorized Person:

Name:

KITTY L CARMICHAEL

Role:

ARNP

Phone:

3604355365

Taxonomy:

Selected Taxonomy:

173000000X - Legal Medicine

Is Primary:

Yes

Contacts:

Fax:

3604741394

DIABETES MANAGEMENT NORTHWEST, P.S.

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Registered Agent Information

Key Officers & Management

National Provider Identifier

Authorized Person:

Taxonomy:

Contacts:

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