Individual
HEATHER FAZEKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2201 N 30TH ST STE B, TACOMA, WA 98403-3361
(253) 355-3605
Mailing address
2201 N 30TH ST STE B, TACOMA, WA 98403-3361
(253) 355-3605
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP1590700
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HALEHM156NK
DRIVERS LICENSE
WA
Enumeration date
11/21/2018
Last updated
11/04/2024
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