Healthcare Provider Details

I. General information

NPI: 1669628004
Provider Name (Legal Business Name): ELIZABETH ANNE SEYMOUR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANNE SEYMOUR DE CORTES RN

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W. 4TH AVE
KENNEWICK WA
99336
US

IV. Provider business mailing address

6305 CHAPEL HILL BLVD APT. D202
PASCO WA
99301
US

V. Phone/Fax

Practice location:
  • Phone: 509-222-5261
  • Fax: 509-222-5054
Mailing address:
  • Phone: 509-778-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00158360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: