Provider Demographics
NPI:1992982789
Name:MONICA NELSON
Entity type:Organization
Organization Name:MONICA NELSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSTRANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-759-3065
Mailing Address - Street 1:22813 43RD AVE S
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-8468
Mailing Address - Country:US
Mailing Address - Phone:206-948-5899
Mailing Address - Fax:253-759-3075
Practice Address - Street 1:22813 43RD AVE S
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2000
Practice Address - Country:US
Practice Address - Phone:206-948-5899
Practice Address - Fax:253-759-3075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONICA NELSON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-24
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643776Medicaid
GAB36914Medicare PIN
WA9643776Medicaid