Provider Demographics
NPI:1528124492
Name:FATHI, JOELLE P (DNP, RN, ARNP)
Entity type:Individual
Prefix:PROF
First Name:JOELLE
Middle Name:P
Last Name:FATHI
Suffix:
Gender:F
Credentials:DNP, RN, ARNP
Other - Prefix:PROF
Other - First Name:JOELLE
Other - Middle Name:P
Other - Last Name:FATHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 MADISON ST
Mailing Address - Street 2:STE 900
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1306
Mailing Address - Country:US
Mailing Address - Phone:206-215-6800
Mailing Address - Fax:206-215-6801
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:STE 900
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-215-6800
Practice Address - Fax:206-215-6801
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005597363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9627480Medicaid
P03924Medicare UPIN
WA8855999Medicare ID - Type Unspecified