Provider Demographics
NPI:1386945905
Name:WASSERMAN, ADRIENNE E (ARNP)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:E
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:E
Other - Last Name:BADORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:855-963-2100
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:420 MCPHEE RD SW STE A
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4070
Practice Address - Country:US
Practice Address - Phone:360-352-9200
Practice Address - Fax:360-810-3697
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60649951163W00000X, 363LA2200X
WAAP606493681363LA2200X, 363L00000X
WAAP60649381363LA2200X
PASP011162363LA2200X
CA20725363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner