Facts
- Status
- A
- Credential
- ARNP
- Type
- Individual
- Enumeration date
- 2022-09-01
- Last updated
- 2022-09-01
Specialties
Licenses
- License WA
- AP61354263
Location
- Practice location
- 853 WATSON ST N
- City
- ENUMCLAW WA
- Postal code
- 980223948
- Phone
- 360-768-4045
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.