Healthcare Provider Details

I. General information

NPI: 1477876449
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF WISONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 08/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CASCADE AVE
GIG HARBOR WA
98335-1971
US

IV. Provider business mailing address

6601 CASCADE AVE
GIG HARBOR WA
98335-1971
US

V. Phone/Fax

Practice location:
  • Phone: 310-995-7642
  • Fax:
Mailing address:
  • Phone: 310-995-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number3834033
License Number StateWI

VIII. Authorized Official

Name: MRS. REBECCA DANVERS YUAN
Title or Position: NEONATAL NURSE PRACTITIONER
Credential: NNP-BC,APNP
Phone: 414-266-2950