Provider Demographics
NPI:1518261148
Name:ANNE HORSLEY ADVANCED PRACTICE REGISTERED NURSE PLLC
Entity Type:Organization
Organization Name:ANNE HORSLEY ADVANCED PRACTICE REGISTERED NURSE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:253-212-0202
Mailing Address - Street 1:1720 E 67TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4223
Mailing Address - Country:US
Mailing Address - Phone:253-212-0202
Mailing Address - Fax:253-212-0962
Practice Address - Street 1:1720 E 67TH ST STE 119
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4223
Practice Address - Country:US
Practice Address - Phone:253-212-0202
Practice Address - Fax:253-212-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60190542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1518261148Medicaid
WAG8898177Medicare PIN