Provider Demographics
NPI:1194798991
Name:LEDELL-HONG, ANNE M (ARNP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:LEDELL-HONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0000
Mailing Address - Country:US
Mailing Address - Phone:360-779-4444
Mailing Address - Fax:360-697-2514
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-0000
Practice Address - Country:US
Practice Address - Phone:360-779-4444
Practice Address - Fax:360-697-2514
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3001960363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604232Medicaid
G8894355Medicare PIN
WAS71503Medicare UPIN
WAGAB07401Medicare PIN