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General NPI Number Information
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NPI Number | 1619880739
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Entity Type | Organization
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Legal Business Name | WILDWOOD WELLNESS PLLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 1523 132ND ST SE STE C-1028
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City | EVERETT
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State | WA
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Zip | 98208-7200
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Country | US
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Telephone | 425-332-8312
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Fax |
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Provider Business Mailing Address
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Address Line | 2819 99TH PL SE
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City | EVERETT
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State | WA
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Zip | 98208-2974
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Country | US
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Telephone | 843-442-9864
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | DESIREE BALLESTEROS
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Credential | ARNP
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Telephone | 425-332-8312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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