Healthcare Provider Details

I. General information

NPI: 1043092174
Provider Name (Legal Business Name): NORTH COAST NOMAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 12/19/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 RIVER RD
SEQUIM WA
98382-7708
US

IV. Provider business mailing address

2533 RIVER RD
SEQUIM WA
98382-7708
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-5709
  • Fax: 360-683-2397
Mailing address:
  • Phone: 360-683-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STEVEN M HIGGS
Title or Position: PRESIDENT/CEO/OWNER
Credential: RN
Phone: 360-305-7803