# THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC

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

## Provider details

- **NPI number:** 1912606237
- **Authorized official:** JESSICA RYAN RN,NP,AANP (OWNER)
- **Authorized official phone:** (808) 772-3715

## Contact information

- **Practice address:** 4110 61ST CT SW, TUMWATER, WA 98512-7043
- **Practice address phone:** (808) 772-3715
- **Mailing address:** 4110 61ST CT SW, TUMWATER, WA 98512-7043
- **Mailing address phone:** (808) 772-3715

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/24/2023
- **Last updated:** 08/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 60328811 | RN | WA |
| 01 | — | 60909311 | NP | WA |
| 01 | — | F10180045 | AANP | WA |