Provider Demographics
NPI:1194442954
Name:ADVANCED GERIATRIC CARE PLLC
Entity type:Organization
Organization Name:ADVANCED GERIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:SELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEFANOS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:415-746-0007
Mailing Address - Street 1:17418 159TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-9153
Mailing Address - Country:US
Mailing Address - Phone:415-746-0007
Mailing Address - Fax:
Practice Address - Street 1:17418 159TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-9153
Practice Address - Country:US
Practice Address - Phone:415-746-0007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty