Provider Demographics
NPI:1346640588
Name:CHITILA JAMES, PHOEBE (NP)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:
Last Name:CHITILA JAMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PHOEBE
Other - Middle Name:N'GONGA
Other - Last Name:CHITILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
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 1:751 NE BLAKELY DR STE 1090
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6201
Practice Address - Country:US
Practice Address - Phone:206-386-2552
Practice Address - Fax:206-215-3959
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001134363LF0000X
WAAP60670305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily