Individual
THOMAS LEE ETHERTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
2610 YELM HWY SE, OLYMPIA, WA 98501-4826
(360) 915-9389
Mailing address
2610 YELM HWY SE, OLYMPIA, WA 98501-4826
(360) 915-9389
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP61034795
WA
Other
Enumeration date
01/14/2020
Last updated
08/12/2021
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