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General NPI Number Information
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NPI Number | 1356469720
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Entity Type | Organization
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Legal Business Name | IN HOME PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 127 AVENUE A BAY 3 STE 1 & 2
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City | SNOHOMISH
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State | WA
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Zip | 98290-2962
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Country | US
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Telephone | 360-863-3657
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Fax | 360-863-6295
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Provider Business Mailing Address
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Address Line | 127 AVENUE A BAY 3 STE 1 & 2
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City | SNOHOMISH
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State | WA
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Zip | 98290-2962
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Country | US
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Telephone | 360-863-3657
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Fax | 360-863-6295
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | BETTY A WESTFALL
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Credential | MN,ARNP
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Telephone | 360-863-3657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP30005721
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License Number State | WA
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