Individual
THEPTHARA NUI PHOLSENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17707 W MAIN ST, 1ST FL, MONROE, WA 98272-1967
(360) 282-3885
(360) 282-3886
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
(206) 764-3335
(206) 764-0489
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP60248306
WA
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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