Provider Demographics
NPI:1104961366
Name:TAKAMIYA, ROBYNN M (ARNP)
Entity type:Individual
Prefix:
First Name:ROBYNN
Middle Name:M
Last Name:TAKAMIYA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROBYNN
Other - Middle Name:M
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-288-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006771363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646118Medicaid
WA0218103OtherL&I
WA8877561Medicare PIN
WA0218103OtherL&I
WA8855070Medicare ID - Type UnspecifiedUW PHYSICIANS