Provider Demographics
NPI:1104021161
Name:WOMENS MENTAL HEALTH SERVICES AND MEDICATION MANAGEMENT LTD, PS
Entity Type:Organization
Organization Name:WOMENS MENTAL HEALTH SERVICES AND MEDICATION MANAGEMENT LTD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIXIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-943-4411
Mailing Address - Street 1:780 SWIFT BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3587
Mailing Address - Country:US
Mailing Address - Phone:509-943-4411
Mailing Address - Fax:509-943-4041
Practice Address - Street 1:780 SWIFT BLVD STE 350
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3587
Practice Address - Country:US
Practice Address - Phone:509-943-4411
Practice Address - Fax:509-943-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003555363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty