Basic Information
| Provider Information | |||||||||
| NPI: | 1174280663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED NP CONSULTATION LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 S VASSAULT ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984652008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534443320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 S VASSAULT ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984652008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534443320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | IRVIN | ||||||||
| AuthorizedOfficialFirstName: | CORENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2534443320 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | AP60978206 | 01 | WA | LICENSE | OTHER |