Provider Demographics
NPI:1144941501
Name:WEISS, EMILYN KATHERINE (ARNP)
Entity type:Individual
Prefix:
First Name:EMILYN
Middle Name:KATHERINE
Last Name:WEISS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KITTY
Other - Middle Name:
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:629 AVENUE D STE 1
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2303
Mailing Address - Country:US
Mailing Address - Phone:360-568-1554
Mailing Address - Fax:
Practice Address - Street 1:629 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2303
Practice Address - Country:US
Practice Address - Phone:360-568-1554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61327901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily