Provider Demographics
NPI:1598470270
Name:NORTHWEST NURSE DELEGATION PLLC
Entity Type:Organization
Organization Name:NORTHWEST NURSE DELEGATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:BEARDSLEY
Authorized Official - Last Name:L.
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-409-8310
Mailing Address - Street 1:303 W OWENS RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9321
Mailing Address - Country:US
Mailing Address - Phone:206-409-8310
Mailing Address - Fax:509-297-7903
Practice Address - Street 1:303 W OWENS RD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-9321
Practice Address - Country:US
Practice Address - Phone:206-409-8310
Practice Address - Fax:509-297-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604993240Medicaid