| NPI | 1801609292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA CHARLES A RN P 360-259-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2026-03-28 |