Provider Demographics
NPI:1326799388
Name:GOLEZ, PAULINE VINTAPATR
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:VINTAPATR
Last Name:GOLEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:C
Other - Last Name:VINTAPATR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5103
Mailing Address - Country:US
Mailing Address - Phone:800-562-6300
Mailing Address - Fax:877-515-2975
Practice Address - Street 1:5925 47TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270
Practice Address - Country:US
Practice Address - Phone:855-722-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95190211163W00000X
WAAP61428637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse