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General NPI Number Information
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NPI Number | 1790272920
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Entity Type | Individual
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Provider Name | MERCY ITESA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 7507 NE 51ST ST
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City | VANCOUVER
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State | WA
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Zip | 98662-6007
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Country | US
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Telephone | 682-336-1059
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Fax | 817-607-8748
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Provider Business Mailing Address
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Address Line | 10655 NE 4TH ST STE 901
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City | BELLEVUE
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State | WA
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Zip | 98004-5030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1016777
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 61852
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 61114929
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License Number State | WA
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