Provider Demographics
NPI:1013255058
Name:STORM, HEATHER (LPN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STORM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:RITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2929 MCDOUGALL AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:42018 264TH AVE SE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-8367
Practice Address - Country:US
Practice Address - Phone:360-802-7492
Practice Address - Fax:360-802-7500
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60198379164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse