MEDICARE: HOLISTIC HOME AND COMMUNITY CLINIC PLLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1669233961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HOME AND COMMUNITY CLINIC PLLC

Provider Business Mailing Address
First Line	:	19925 154TH ST E
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-7489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32700 PACIFIC HWY S
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-6446
Country	:	US
Telephone Number	:	574-707-5898
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARTHA MBURU
Credential	:
Telephone Number	:	574-707-5898

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	06/24/2024

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