Provider Demographics
NPI:1801036017
Name:LKI- NURTURED HEART CENTER
Entity Type:Organization
Organization Name:LKI- NURTURED HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-403-7526
Mailing Address - Street 1:20902 67TH AVE NE # 365
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8274
Mailing Address - Country:US
Mailing Address - Phone:360-403-7526
Mailing Address - Fax:360-403-3264
Practice Address - Street 1:102 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1235
Practice Address - Country:US
Practice Address - Phone:360-403-7526
Practice Address - Fax:360-403-3264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LKI FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60013935363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty