Provider Demographics
NPI:1790014223
Name:NURSE PRACTITIONERS NORTHWEST, PLLC
Entity Type:Organization
Organization Name:NURSE PRACTITIONERS NORTHWEST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ELVIRA
Authorized Official - Last Name:SACKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-797-6239
Mailing Address - Street 1:PO BOX 23838
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98093-0838
Mailing Address - Country:US
Mailing Address - Phone:253-797-6239
Mailing Address - Fax:253-927-2119
Practice Address - Street 1:5115 BEVERLY AVENUE NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1823
Practice Address - Country:US
Practice Address - Phone:253-797-6239
Practice Address - Fax:253-927-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001790363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005946Medicaid
WA2005946Medicaid