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Nursing Service Providers Licensed Practical Nurse

Provider NPI: 1063879898

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
4012 WIGGINS RD SE  OLYMPIA, WA 98501-4372 US
Tel: 360-825-6525  Fax: --

Business Mailing Address:
4012 WIGGINS RD SE  OLYMPIA, WA 98501-4372 US
Tel: --  Fax: --

NPI Information:
NPI: 1063879898
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y164W00000XNursing Service Providers
Licensed Practical Nurse

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 164W00000X





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