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Organization
THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC
Active
Organization
THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RYAN RN,NP,AANP (OWNER)
(808) 772-3715
Entity
Organization
Contact information
Practice address
4110 61ST CT SW, TUMWATER, WA 98512-7043
(808) 772-3715
Mailing address
4110 61ST CT SW, TUMWATER, WA 98512-7043
(808) 772-3715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60328811
RN
WA
01
—
60909311
NP
WA
01
—
F10180045
AANP
WA
Enumeration date
02/24/2023
Last updated
08/28/2023
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