Provider Demographics
NPI:1902977473
Name:CHRISTOFERSON, JOY A (MSN, ARNP)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A
Last Name:CHRISTOFERSON
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4554 33RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1602
Mailing Address - Country:US
Mailing Address - Phone:206-329-2814
Mailing Address - Fax:
Practice Address - Street 1:1105 S 348TH ST STE B103
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7027
Practice Address - Country:US
Practice Address - Phone:253-661-7002
Practice Address - Fax:253-661-9132
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006090363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635251Medicaid