Healthcare Provider Details

I. General information

NPI: 1255816872
Provider Name (Legal Business Name): HIEDI WURSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10710 MUKILTEO SPEEDWAY
MUKILTEO WA
98275-5021
US

IV. Provider business mailing address

914 164TH ST SE # 503
MILL CREEK WA
98012-6385
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-8888
  • Fax:
Mailing address:
  • Phone: 425-225-6560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN60624720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: