Healthcare Provider Details

I. General information

NPI: 1265909063
Provider Name (Legal Business Name): ANNALEE WOLTERS RN., BSN.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ORAVETZ RD SE
AUBURN WA
98092-8621
US

IV. Provider business mailing address

15715 236TH AVE E
ORTING WA
98360-9673
US

V. Phone/Fax

Practice location:
  • Phone: 253-804-5161
  • Fax: 253-804-5168
Mailing address:
  • Phone: 253-880-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60384299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: