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General NPI Number Information
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NPI Number | 1801163282
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FAMILY CLINIC LLC
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 114 E CHANCE A LA MER NE # 107
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City | OCEAN SHORES
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State | WA
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Zip | 98569-9202
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Country | US
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Telephone | 360-940-7465
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1574
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City | OCEAN SHORES
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State | WA
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Zip | 98569-1574
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Country | US
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Telephone | 360-940-7465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM THOMAS MILLER
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Credential | ARNP
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Telephone | 360-940-7465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP60249842
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License Number State | WA
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