Healthcare Provider Details

I. General information

NPI: 1174336325
Provider Name (Legal Business Name): ANN-MARIE Y OBUTEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

IV. Provider business mailing address

9740 S TACOMA WAY
LAKEWOOD WA
98499-4456
US

V. Phone/Fax

Practice location:
  • Phone: 253-604-7422
  • Fax:
Mailing address:
  • Phone: 253-503-3666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.LP.61567989.MSL
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: