Provider Demographics
NPI:1841405982
Name:EWH INC
Entity Type:Organization
Organization Name:EWH INC
Other - Org Name:EASTSIDE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNUSON-WHYTE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, ARNP, PMHNP, BC
Authorized Official - Phone:360-943-5127
Mailing Address - Street 1:1100 EASTSIDE ST SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-7304
Mailing Address - Country:US
Mailing Address - Phone:360-943-5127
Mailing Address - Fax:360-754-2516
Practice Address - Street 1:1100 EASTSIDE ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-7304
Practice Address - Country:US
Practice Address - Phone:360-943-5127
Practice Address - Fax:360-754-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAUBI601998920363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7900491Medicaid
WA7099070Medicaid
WA7099070Medicaid