Provider Demographics
NPI:1992874390
Name:MATHIS, PATRICIA A (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:MATHIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11206 152ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6021
Mailing Address - Country:US
Mailing Address - Phone:206-799-4891
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4695
Practice Address - Country:US
Practice Address - Phone:425-635-3400
Practice Address - Fax:425-688-0213
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862921Medicare PIN