Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP30001367 | WA |
NPI | 1013012152 |
---|---|
Provider Name | Phyllis Holzworth |
First Address | Seattle, WA 98104-2474 |
Second Address | Seattle, WA 98116-3302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
961586 | (05) | WA |