Organization
INFANT HOME PHOTOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA LEE GENTRY-HAYWARD RN, BSN, MBA-HCA (PRESIDENT)
(425) 355-0957
Entity
Organization
Contact information
Practice address
4908 33RD AVE W, EVERETT, WA 98203-1338
(425) 355-0957
Mailing address
PO BOX 1328, MUKILTEO, WA 98275-1328
(425) 355-0957
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
IS-342
WA
Other
Enumeration date
03/05/2007
Last updated
04/25/2013
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