Provider Demographics
NPI:1609116292
Name:MYNURSE
Entity Type:Organization
Organization Name:MYNURSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAB
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-670-2909
Mailing Address - Street 1:316 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7606
Mailing Address - Country:US
Mailing Address - Phone:360-670-2909
Mailing Address - Fax:
Practice Address - Street 1:316 W 12TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7606
Practice Address - Country:US
Practice Address - Phone:360-670-2909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00107121251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health