Provider Demographics
NPI:1942573969
Name:STORLIE, NICOLE WRAYANN (ARNP PMHNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:WRAYANN
Last Name:STORLIE
Suffix:
Gender:F
Credentials:ARNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2689
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2689
Mailing Address - Country:US
Mailing Address - Phone:095-426-4790
Mailing Address - Fax:509-554-4497
Practice Address - Street 1:1200 CHESTERLY DR STE 100
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7339
Practice Address - Country:US
Practice Address - Phone:509-426-4790
Practice Address - Fax:509-554-5597
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 60203300163WC1500X
WAAP60909283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health