Healthcare Provider Details

I. General information

NPI: 1255952701
Provider Name (Legal Business Name): EMILY GRACE MAGWIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19835 10TH AVE NE STE B
POULSBO WA
98370-7451
US

IV. Provider business mailing address

19835 10TH AVE NE STE B
POULSBO WA
98370-7451
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-7011
  • Fax:
Mailing address:
  • Phone: 360-779-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61052646
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: