Provider Demographics
NPI:1033347422
Name:BYWATER MEDICAL CONSULTANTS PLLC
Entity Type:Organization
Organization Name:BYWATER MEDICAL CONSULTANTS PLLC
Other - Org Name:BYWATER PSYCHIATRIC CONSULTATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-708-9741
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-1627
Mailing Address - Country:US
Mailing Address - Phone:360-708-9741
Mailing Address - Fax:801-780-9741
Practice Address - Street 1:1911 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-6703
Practice Address - Country:US
Practice Address - Phone:360-708-9741
Practice Address - Fax:360-588-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007181363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty