Healthcare Provider Details

I. General information

NPI: 1104021161
Provider Name (Legal Business Name): WOMENS MENTAL HEALTH SERVICES AND MEDICATION MANAGEMENT LTD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SWIFT BLVD STE 350
RICHLAND WA
99352-3587
US

IV. Provider business mailing address

780 SWIFT BLVD STE 350
RICHLAND WA
99352-3587
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-4411
  • Fax: 509-943-4041
Mailing address:
  • Phone: 509-943-4411
  • Fax: 509-943-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30003555
License Number StateWA

VIII. Authorized Official

Name: MS. DIXIE BONE
Title or Position: PRESIDENT
Credential: ARNP
Phone: 509-943-4411