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NPI Code Detail

MEDICARE: NANCY HESSELROTH

MEDICARE: NANCY HESSELROTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH60569981WA

General Provider Information

NPI Number : 1063879856
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY HESSELROTH
Provider Business Mailing Address
First Line : 5700 E LAKE SAMMAMISH PKWY SE
Second Line :
City : ISSAQUAH
State : WA
Zip : 98029-8914
Country : US
Telephone Number : 360-510-0328
Fax Number :
Provider Business Practice Location Address
First Line : 5700 E LAKE SAMMAMISH PKWY SE
Second Line :
City : ISSAQUAH
State : WA
Zip : 98029-8914
Country : US
Telephone Number : 360-510-0328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2016
Last Update Date : 01/25/2016

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Directions to “ NANCY HESSELROTH ” Practice Location

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