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General NPI Number Information
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NPI Number | 1649415720
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Entity Type | Organization
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Legal Business Name | PACIFIC LUTHERAN UNIVERISTY STUDENT HEALTH CENTER
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Dates
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Enumeration Date | 12/03/2008
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Last Update Date | 12/03/2008
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Provider Practice Location Address
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Address Line | PACIFIC LUTHERAN UNIVERSITY STUDENT HEALTH CTR 12012 PARK AVE SOUTH
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City | TACOMA
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State | WA
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Zip | 98447-0001
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Country | US
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Telephone | 253-535-7337
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Fax |
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Provider Business Mailing Address
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Address Line | 4018 CALDWELL RD E
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City | EDGEWOOD
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State | WA
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Zip | 98372-9234
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Country | US
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Telephone | 253-862-1050
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | MRS. ANN WINNIFRED MILLER
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Credential | ARNP
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Telephone | 253-862-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 910565571
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License Number State | WA
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