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General NPI Number Information
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NPI Number | 1649535642
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP INC PS
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 09/23/2016
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Provider Practice Location Address
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Address Line | 1909 214TH ST SE SUITE 211
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City | BOTHELL
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State | WA
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Zip | 98021-4412
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Country | US
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Telephone | 425-259-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 W MARINE VIEW DR
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City | EVERETT
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State | WA
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Zip | 98201-2094
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Country | US
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Telephone | 425-259-4041
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Fax |
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Authorized Official
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Title or Position | DIRECTOR PFS
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Name | KIM HOLSTEIN
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Credential |
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Telephone | 425-259-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | WA
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