Individual
MERCY ITESA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
7507 NE 51ST ST, VANCOUVER, WA 98662-6007
(682) 336-1059
(817) 607-8748
Mailing address
10655 NE 4TH ST STE 901, BELLEVUE, WA 98004-5030
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1016777
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
61114929
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
61852
NM
Other
Enumeration date
04/13/2018
Last updated
12/27/2023
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