Organization
THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA RYAN RN,NP,AANP (OWNER)
(808) 772-3715
Entity
Organization
Contact information
Practice address
4110 61ST CT SW, TUMWATER, WA 98512-7043
(808) 772-3715
Mailing address
4110 61ST CT SW, TUMWATER, WA 98512-7043
(808) 772-3715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60328811
RN
WA
01
—
60909311
NP
WA
01
—
F10180045
AANP
WA
Enumeration date
02/24/2023
Last updated
08/28/2023
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