Provider Demographics
NPI:1073189817
Name:BAVASI, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAVASI
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 1:900 PACIFIC AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4189
Mailing Address - Country:US
Mailing Address - Phone:425-303-6500
Mailing Address - Fax:
Practice Address - Street 1:858 NW 90TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3258
Practice Address - Country:US
Practice Address - Phone:206-419-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60282751163WE0003X
WAAP61351969363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WE0003XNursing Service ProvidersRegistered NurseEmergency