Provider Demographics
NPI:1730521329
Name:AMISTOSO, JOAN M (ARNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:AMISTOSO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:SCRIPTURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:14410 SE PETROVITSKY RD
Practice Address - Street 2:STE 104
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-656-4242
Practice Address - Fax:425-254-0912
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60347636363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily