Provider Demographics
NPI:1316282411
Name:EGLESTON GERICH, ANNE W (FNP BC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:W
Last Name:EGLESTON GERICH
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:E
Other - Last Name:GERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP BC
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:21911 76TH AVE W STE 110
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7918
Practice Address - Country:US
Practice Address - Phone:425-640-4950
Practice Address - Fax:425-640-4958
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60315860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily