Healthcare Provider Details

I. General information

NPI: 1346987971
Provider Name (Legal Business Name): THERESE NICOLE DE LA TORRE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207-0001
US

IV. Provider business mailing address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207-0001
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4330
  • Fax:
Mailing address:
  • Phone: 425-304-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number850428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: