Healthcare Provider Details

I. General information

NPI: 1790014223
Provider Name (Legal Business Name): NURSE PRACTITIONERS NORTHWEST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 BEVERLY AVENUE NE
TACOMA WA
98422-1823
US

IV. Provider business mailing address

PO BOX 23838
FEDERAL WAY WA
98093-0838
US

V. Phone/Fax

Practice location:
  • Phone: 253-797-6239
  • Fax: 253-927-2119
Mailing address:
  • Phone: 253-797-6239
  • Fax: 253-927-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30001790
License Number StateWA

VIII. Authorized Official

Name: MARGARET ELVIRA SACKMANN
Title or Position: OWNER
Credential: ARNP
Phone: 253-797-6239