Provider Demographics
NPI:1124710140
Name:ENEJE, PATRICK C (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:C
Last Name:ENEJE
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LENORA ST # 6083
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-2411
Mailing Address - Country:US
Mailing Address - Phone:206-330-4022
Mailing Address - Fax:
Practice Address - Street 1:17415 52ND AVE W UNIT 4
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-3082
Practice Address - Country:US
Practice Address - Phone:206-330-4022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61439156363LP0808X
TN33888363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health