Healthcare Provider Details

I. General information

NPI: 1821468596
Provider Name (Legal Business Name): WEST SOUND DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19917 7TH AVE NE STE 203
POULSBO WA
98370-6555
US

IV. Provider business mailing address

19917 7TH AVE NE STE 203
POULSBO WA
98370-6555
US

V. Phone/Fax

Practice location:
  • Phone: 360-824-5474
  • Fax:
Mailing address:
  • Phone: 360-824-5474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31070
License Number StateWA

VIII. Authorized Official

Name: DR. SIMONE INCE
Title or Position: OWNER
Credential: M.D.
Phone: 360-824-5474