Active NPI
The Sweet Life Advanced Diabetes Management LLC
- Nurse Practitioner
- Tumwater, WA
National Provider Identifier
1912606237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC
- Practice address
- 4110 61St CT SW
Tumwater, WA 98512-7043 - Phone
- (808) 772-3715
- NPI assigned
- Feb 24, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jessica Ryan, RN,NP,AANP
- Title
- Owner
- Phone
- (808) 772-3715
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
4110 61St CT SW
Tumwater, WA 98512-7043
Mailing address
4110 61St CT SW
Tumwater, WA 98512-7043
Phone (808) 772-3715
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60328811 | Other | WA | RN |
| F10180045 | Other | WA | AANP |
| 60909311 | Other | WA | NP |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Rochester, WA
- NPI 1407322670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677196800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1693180800000",
"number": "1912606237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4110 61ST CT SW",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985127043",
"telephone_number": "808-772-3715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4110 61ST CT SW",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985127043",
"telephone_number": "808-772-3715"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE SWEET LIFE ADVANCED DIABETES MANAGEMENT LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-02-24",
"last_updated": "2023-08-28",
"certification_date": "2023-08-28",
"status": "A",
"authorized_official_last_name": "RYAN",
"authorized_official_first_name": "JESSICA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "808-772-3715",
"authorized_official_credential": "RN,NP,AANP"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN",
"identifier": "60328811",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AANP",
"identifier": "F10180045",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NP",
"identifier": "60909311",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tumwater, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.