Provider Demographics
NPI:1558193219
Name:RADDATZ, DENISE LEE (ARNP, AGNP-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LEE
Last Name:RADDATZ
Suffix:
Gender:F
Credentials:ARNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 186TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-5168
Mailing Address - Country:US
Mailing Address - Phone:931-614-8824
Mailing Address - Fax:
Practice Address - Street 1:3700 PACIFIC HWY E STE 100
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1160
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:253-382-6301
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAG07240176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty