# INFANT HOME PHOTOTHERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609905751
- **Authorized official:** MRS. DONNA LEE GENTRY-HAYWARD RN, BSN, MBA-HCA (PRESIDENT)
- **Authorized official phone:** (425) 355-0957

## Contact information

- **Practice address:** 4908 33RD AVE W, EVERETT, WA 98203-1338
- **Practice address phone:** (425) 355-0957
- **Mailing address:** PO BOX 1328, MUKILTEO, WA 98275-1328
- **Mailing address phone:** (425) 355-0957

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | IS-342 | WA | Yes |

## Other

- **Enumeration date:** 03/05/2007
- **Last updated:** 04/25/2013