Provider Demographics
NPI:1700373321
Name:OLYMPIC PENINSULA HEALTH SERVICES
Entity Type:Organization
Organization Name:OLYMPIC PENINSULA HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAILONI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-531-4272
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:PORT HADLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98339-0574
Mailing Address - Country:US
Mailing Address - Phone:360-531-4272
Mailing Address - Fax:
Practice Address - Street 1:661 NESS CORNER RD
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339-9410
Practice Address - Country:US
Practice Address - Phone:360-912-5777
Practice Address - Fax:206-472-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty