Healthcare Provider Details

I. General information

NPI: 1104606045
Provider Name (Legal Business Name): HEATHER WYMAN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
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: 425-562-2000
  • Fax: 425-249-3064
Mailing address:
  • Phone: 425-614-8404
  • Fax: 425-249-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61491134
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: