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General NPI Number Information
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NPI Number | 1790139483
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Entity Type | Organization
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Legal Business Name | NORTHWEST MEDICAL ALLIES PLLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 3100 NW BUCKLIN HILL RD SUITE # 105
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City | SILVERDALE
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State | WA
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Zip | 98383-8358
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Country | US
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Telephone | 360-536-2798
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Fax |
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Provider Business Mailing Address
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Address Line | 3709 NW 29TH ST
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City | BREMERTON
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State | WA
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Zip | 98312-1966
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Country | US
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Telephone | 360-536-2798
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JESSETT POCUIS
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Credential | DNP, ARNP
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Telephone | 360-536-2798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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