Provider Demographics
NPI:1033419221
Name:HOPE FAMILY MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:HOPE FAMILY MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER, BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELSBETH
Authorized Official - Last Name:JOHANN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-876-2006
Mailing Address - Street 1:7614 195TH ST SW
Mailing Address - Street 2:STE 203
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6260
Mailing Address - Country:US
Mailing Address - Phone:425-744-0709
Mailing Address - Fax:425-771-1470
Practice Address - Street 1:7614 195TH ST SW
Practice Address - Street 2:STE 203
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6260
Practice Address - Country:US
Practice Address - Phone:425-744-0709
Practice Address - Fax:425-771-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI 603 043 924261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care