Healthcare Provider Details

I. General information

NPI: 1538317797
Provider Name (Legal Business Name): PUGET SOUND HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 N SHIRLEY ST
TACOMA WA
98407-2586
US

IV. Provider business mailing address

3205 N SHIRLEY ST
TACOMA WA
98407-2586
US

V. Phone/Fax

Practice location:
  • Phone: 253-752-5288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberRN 00065202
License Number StateWA

VIII. Authorized Official

Name: DEBRA WINSTON-HEATH
Title or Position: REGISTERED NURSE
Credential:
Phone: 253-583-1168