Healthcare Provider Details

I. General information

NPI: 1194877662
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF WESTERN WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 GOLDIE RD
OAK HARBOR WA
98277-2703
US

IV. Provider business mailing address

3159 GOLDIE RD
OAK HARBOR WA
98277-2703
US

V. Phone/Fax

Practice location:
  • Phone: 360-679-3404
  • Fax: 360-679-4019
Mailing address:
  • Phone: 360-679-3404
  • Fax: 360-679-4019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License NumberAP30002032
License Number StateWA

VIII. Authorized Official

Name: MRS. DIANA LYNN PUTNEY
Title or Position: NURSE PRACTITIONER
Credential: ANRP
Phone: 360-679-3404