Provider Demographics
NPI:1699369926
Name:BEAUTIFULLY AT HOME LLC
Entity Type:Organization
Organization Name:BEAUTIFULLY AT HOME LLC
Other - Org Name:BEAUTIFULLY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:360-471-9368
Mailing Address - Street 1:13866 SYMINGTON PKWY NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-9657
Mailing Address - Country:US
Mailing Address - Phone:360-471-9368
Mailing Address - Fax:
Practice Address - Street 1:13866 SYMINGTON PKWY NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-9657
Practice Address - Country:US
Practice Address - Phone:360-471-9368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty