Healthcare Provider Details

I. General information

NPI: 1386199438
Provider Name (Legal Business Name): NINA WYCOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 LAKE CITY WAY NE
SEATTLE WA
98125-6748
US

IV. Provider business mailing address

15914 44TH AVE W #D203
LYNNWOOD WA
98087-6188
US

V. Phone/Fax

Practice location:
  • Phone: 206-351-4498
  • Fax: 206-547-5265
Mailing address:
  • Phone: 206-351-4498
  • Fax: 206-547-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: