Individual
REBECCA LOUISE FORMOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1321 COLBY AVE, EVERETT, WA 98201-1665
(425) 261-2000
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60860345
WA
363LF0000X
Family Nurse Practitioner
7088
WI
Other
Enumeration date
08/01/2016
Last updated
09/12/2018
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