MEDICARE: ADAM WOOLERY RN

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
1	390200000X	Student in an Organized Health Care Education/Training Program	RN.RN.60293862	WA

General Provider Information

NPI Number	:	1194651174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM WOOLERY RN

Provider Business Mailing Address
First Line	:	4505 90TH WAY SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-5610
Country	:	US
Telephone Number	:	360-491-9480
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 LILLY RD NE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5133
Country	:	US
Telephone Number	:	360-491-9480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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