MEDICARE: WOMENS WELLNESS 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	207V00000X	Obstetrics & Gynecology Physician	MD00040581	WA

General Provider Information

NPI Number	:	1801316179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS WELLNESS PLLC

Provider Business Mailing Address
First Line	:	853 WATSON ST N STE 200
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3948
Country	:	US
Telephone Number	:	360-367-2970
Fax Number	:	360-998-3241

Provider Business Practice Location Address
First Line	:	853 WATSON ST N STE 200
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3948
Country	:	US
Telephone Number	:	360-367-2970
Fax Number	:	360-998-3241

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	HOLLY A DICKSON
Credential	:	MD
Telephone Number	:	360-367-2970

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	03/04/2026

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