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General NPI Number Information
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NPI Number | 1336584119
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Entity Type | Organization
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Legal Business Name | WATER'S EDGE FAMILY PRACTICE & WELLNESS CENTER
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 221 SECOND STREET
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City | LANGLEY
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State | WA
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Zip | 98260
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Country | US
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Telephone | 360-221-1060
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Fax | 360-221-1062
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Provider Business Mailing Address
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Address Line | PO BOX 1327
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City | LANGLEY
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State | WA
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Zip | 98260-1327
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Country | US
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Telephone | 360-221-1060
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Fax | 360-221-1062
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNASTASIA KOVSCEK
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Credential | M.D.
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Telephone | 360-221-1060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60091880
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License Number State | WA
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