| Evergreen Family Practice, Pllc | |
|
205 Lilly Rd Ne Ste A1 Olympia WA 98506-5069 | |
| (360) 438-3029 | |
| (360) 438-8585 |
| Full Name | Evergreen Family Practice, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 205 Lilly Rd Ne Ste A1, Olympia, Washington |
| Authorized Official Name and Position | Michelle M Warner (OWNER) |
| Authorized Official Contact | 3604383029 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Family Practice, Pllc Po Box 5807 Lacey WA 98509-5807 Ph: (360) 438-3029 | Evergreen Family Practice, Pllc 205 Lilly Rd Ne Ste A1 Olympia WA 98506-5069 Ph: (360) 438-3029 |
| NPI Number | 1932740842 |
|---|---|
| Provider Enumeration Date | 10/01/2019 |
| Last Update Date | 10/01/2019 |
| Medicare PECOS PAC ID | 5092147058 |
|---|---|
| Medicare Enrollment ID | O20191112002807 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932740842 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Michelle Warner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801304431 PECOS PAC ID: 3577812940 Enrollment ID: I20180817000990 |
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