Individual
JULY PAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2913 5TH AVE NE STE 101, PUYALLUP, WA 98372-6748
(855) 255-1750
Mailing address
24025 79TH PL W, EDMONDS, WA 98026-9114
(206) 234-1477
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
60991496
WA
Other
Enumeration date
02/06/2020
Last updated
02/06/2020
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