Provider Demographics
NPI:1699936716
Name:KANIVE, ROBERTA FERN (ARNP)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:FERN
Last Name:KANIVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 177TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-9141
Mailing Address - Country:US
Mailing Address - Phone:360-794-2400
Mailing Address - Fax:
Practice Address - Street 1:16700 177TH AVE SE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-9141
Practice Address - Country:US
Practice Address - Phone:360-794-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3000174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily