Infant Home Phototherapy

Primary specialty

Home Health Registered NurseTaxonomy code 163WH0200X

License

IS-342 Issued in WA

Legal business name

INFANT HOME PHOTOTHERAPY

Practice address

4908 33Rd Ave W
Everett, WA 98203-1338

Phone

(425) 355-0957

NPI assigned

Mar 5, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Donna Lee Gentry-Hayward, RN, BSN, MBA-HCA

Title

President

Phone

(425) 355-0957

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1609905751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "MUKILTEO",
            "state": "WA",
            "postal_code": "982751328",
            "telephone_number": "425-355-0957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4908 33RD AVE W",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982031338",
            "telephone_number": "425-355-0957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INFANT HOME PHOTOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "GENTRY-HAYWARD",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "425-355-0957",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, BSN, MBA-HCA"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": "WA",
            "license": "IS-342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; 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.