Healthcare Provider Details

I. General information

NPI: 1861221434
Provider Name (Legal Business Name): NICOLETTE LIUKKO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 07/31/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E MORRIS ST STE B
LA CONNER WA
98257
US

IV. Provider business mailing address

23025 105TH ST SE
MONROE WA
98272-7880
US

V. Phone/Fax

Practice location:
  • Phone: 360-630-5141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61585061
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: