Provider Demographics
NPI:1407959851
Name:RADO, MITRA (RN, ARNP)
Entity type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:RADO
Suffix:
Gender:F
Credentials:RN, ARNP
Other - Prefix:
Other - First Name:MITRA
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:7360 W. DESCHUTES AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-783-0144
Practice Address - Fax:509-783-8244
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006903363L00000X
WARN00110787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0332816Medicaid
WA9646241Medicaid
WA0332816Medicaid
WA8856271Medicare PIN