NPIMap

Organization Active NPI

Blue Heron Skilled Nursing Services

  • Registered Nurse
  • Quilcene, WA
National Provider Identifier
1205179256
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00058765 Issued in WA
Legal business name
BLUE HERON SKILLED NURSING SERVICES
Practice address
165 Moon Valley Dr
Quilcene, WA 98376-0411
Phone
(360) 301-0478
Fax
(360) 765-3241
NPI assigned
Mar 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Evelyn L Gunther, RN
Title
Partner
Phone
(360) 774-1988

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X RN00058765 WA Primary
Community Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1500X RN00046933 WA
Community Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1500X RN00058765 WA
Home Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WH0200X RN00058765 WA

Addresses

Primary practice location

165 Moon Valley Dr
Quilcene, WA 98376-0411

Mailing address

PO Box 411
Quilcene, WA 98376-0411
Phone (360) 301-0478

Other identifiers 1

IdentifierTypeStateIssuer
322665OtherWAPROVIDER NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1205179256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411",
            "city": "QUILCENE",
            "state": "WA",
            "postal_code": "983760411",
            "telephone_number": "360-301-0478",
            "fax_number": "360-765-3241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 MOON VALLEY DR",
            "city": "QUILCENE",
            "state": "WA",
            "postal_code": "983760411",
            "telephone_number": "360-301-0478",
            "fax_number": "360-765-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON SKILLED NURSING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-28",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "GUNTHER",
        "authorized_official_first_name": "EVELYN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "360-774-1988",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00058765",
            "primary": true
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": "WA",
            "license": "RN00046933",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": "WA",
            "license": "RN00058765",
            "primary": false
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": "WA",
            "license": "RN00058765",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "322665",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quilcene, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.