Provider Demographics
NPI:1528087186
Name:GOLEMBIOWSKI, DAVID ISAAC (ARNP)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ISAAC
Last Name:GOLEMBIOWSKI
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3715
Mailing Address - Country:US
Mailing Address - Phone:253-697-7655
Mailing Address - Fax:253-697-2919
Practice Address - Street 1:401 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3715
Practice Address - Country:US
Practice Address - Phone:253-697-7655
Practice Address - Fax:253-697-2919
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00141784163WC0200X
WAAP60911665363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528087186Medicaid