Healthcare Provider Details

I. General information

NPI: 1861816449
Provider Name (Legal Business Name): ANN SONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CATON WAY SW
OLYMPIA WA
98502
US

IV. Provider business mailing address

PO BOX 13181
OLYMPIA WA
98508-3181
US

V. Phone/Fax

Practice location:
  • Phone: 360-866-7406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00121290
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60971571
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: