Healthcare Provider Details

I. General information

NPI: 1669187548
Provider Name (Legal Business Name): RYAN WILLIS ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 SQUALICUM PKWY STE 100
BELLINGHAM WA
98225-1940
US

IV. Provider business mailing address

3610 MERIDIAN ST
BELLINGHAM WA
98225-1732
US

V. Phone/Fax

Practice location:
  • Phone: 360-671-4509
  • Fax: 360-756-5184
Mailing address:
  • Phone: 360-318-8800
  • Fax: 360-318-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034813
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86832
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15571600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61395684
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF357288-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: