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General NPI Number Information
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NPI Number | 1821081308
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Entity Type | Individual
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Provider Name | PATRICIA LYNN DYKSTRA ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2005
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 850 MAPLE STREET
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0800
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Country | US
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Telephone | 509-565-4000
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Fax | 509-565-4705
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Provider Business Mailing Address
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Address Line | P.O. BOX 800 850 MAPLE STREET
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City | MEDICAL LAKE
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State | WA
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Zip | 99022-0800
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Country | US
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Telephone | 509-565-4000
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Fax | 509-565-4705
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP30007404
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number | RN00164832
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License Number State | WA
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