| NPI | 1992241566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEANN OUTLETT Billing Manager 360-637-9263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP0001451) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2017-01-06 |