Organization
BLUE HERON SKILLED NURSING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN L GUNTHER RN (PARTNER)
(360) 774-1988
Entity
Organization
Contact information
Practice address
165 MOON VALLEY DR, QUILCENE, WA 98376-0411
(360) 301-0478
(360) 765-3241
Mailing address
PO BOX 411, QUILCENE, WA 98376-0411
(360) 301-0478
(360) 765-3241
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN00058765
WA
163WC1500X
Community Health Registered Nurse
RN00046933
WA
163WC1500X
Community Health Registered Nurse
RN00058765
WA
163WH0200X
Home Health Registered Nurse
RN00058765
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
322665
PROVIDER NUMBER
WA
Enumeration date
03/28/2013
Last updated
01/20/2015
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