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General NPI Number Information
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NPI Number | 1033347422
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Entity Type | Organization
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Legal Business Name | BYWATER MEDICAL CONSULTANTS PLLC
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 1911 E DIVISION ST
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City | MOUNT VERNON
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State | WA
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Zip | 98274-6703
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Country | US
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Telephone | 360-708-9741
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Fax | 360-588-4192
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Provider Business Mailing Address
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Address Line | PO BOX 1627
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City | MOUNT VERNON
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State | WA
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Zip | 98273-1627
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Country | US
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Telephone | 360-708-9741
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Fax | 801-780-9741
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH M. HOLMES
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Credential | ARNP
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Telephone | 360-708-9741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP30007181
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License Number State | WA
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