Provider Demographics
NPI:1104606045
Name:WYMAN, HEATHER (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WYMAN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14362 3RD CIR NE
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-8642
Mailing Address - Country:US
Mailing Address - Phone:425-614-8404
Mailing Address - Fax:
Practice Address - Street 1:1048 W LAKE SAMM PKWY NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-4232
Practice Address - Country:US
Practice Address - Phone:425-562-2000
Practice Address - Fax:425-653-7777
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61491134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily