Provider Demographics
NPI:1154837847
Name:DAVIS, FIL BETH GATMAITAN (FNP)
Entity type:Individual
Prefix:
First Name:FIL BETH
Middle Name:GATMAITAN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 CULLENS ST NW
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9417
Practice Address - Country:US
Practice Address - Phone:360-400-4800
Practice Address - Fax:360-400-4821
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK156569363LF0000X
VA0024180624363LF0000X
HI2382363LF0000X
RI03045363LF0000X
WA61422614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2251149Medicaid