Provider Demographics
NPI:1861780264
Name:GEGAX-MARTINEZ, TERESA LYNN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:GEGAX-MARTINEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:GEGAX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 N 115TH ST
Mailing Address - Street 2:MS W-201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8414
Mailing Address - Country:US
Mailing Address - Phone:206-368-1244
Mailing Address - Fax:206-368-1270
Practice Address - Street 1:1560 N 115TH ST
Practice Address - Street 2:MS W-201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8414
Practice Address - Country:US
Practice Address - Phone:206-368-1244
Practice Address - Fax:206-368-1270
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60235412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health