Provider Demographics
NPI:1538352455
Name:JOANNE GIGI HARDTKE, ARNP, PLLC
Entity type:Organization
Organization Name:JOANNE GIGI HARDTKE, ARNP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:GIGI
Authorized Official - Last Name:HARDTKE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-212-0093
Mailing Address - Street 1:3702 S. FIFE K PMB 402
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-212-0093
Mailing Address - Fax:866-375-6026
Practice Address - Street 1:3702 S. FIFE KPMB 402
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-212-0093
Practice Address - Fax:866-375-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP1190132164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA963762Medicaid
WA0132HAOtherREGENCE
WA0132HAOtherREGENCE
WAP81794Medicare UPIN