| NPI | 1649402942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI MICHELLE MANCUSO Family Nurse Practitioner 509-389-6945 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30006855) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2011-09-27 |