Healthcare Provider Details

I. General information

NPI: 1093639049
Provider Name (Legal Business Name): WYNDROSE FAMILY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14362 3RD CIR NE
DUVALL WA
98019-8642
US

IV. Provider business mailing address

14362 3RD CIR NE
DUVALL WA
98019-8642
US

V. Phone/Fax

Practice location:
  • Phone: 425-614-8404
  • Fax: 425-249-3064
Mailing address:
  • Phone:
  • Fax: 425-249-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEATHER WYMAN
Title or Position: OWNER
Credential: NP
Phone: 425-614-8404