Healthcare Provider Details

I. General information

NPI: 1164826350
Provider Name (Legal Business Name): ERIN MICHELLE WATTLES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

IV. Provider business mailing address

17700 SE 272ND ST
COVINGTON WA
98042-4951
US

V. Phone/Fax

Practice location:
  • Phone: 253-372-7155
  • Fax:
Mailing address:
  • Phone: 253-372-7155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60512131
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: