Provider Demographics
NPI:1982597753
Name:NORDHOLM, SCARLET
Entity type:Individual
Prefix:
First Name:SCARLET
Middle Name:
Last Name:NORDHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19522 136TH ST E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-7894
Mailing Address - Country:US
Mailing Address - Phone:704-608-1669
Mailing Address - Fax:
Practice Address - Street 1:19522 136TH ST E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7894
Practice Address - Country:US
Practice Address - Phone:704-608-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant