Healthcare Provider Details

I. General information

NPI: 1851818280
Provider Name (Legal Business Name): PATRICIA SOLOMOS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

IV. Provider business mailing address

1818 COLE ST
ENUMCLAW WA
98022-3504
US

V. Phone/Fax

Practice location:
  • Phone: 360-802-5760
  • Fax: 253-931-0833
Mailing address:
  • Phone: 360-802-5760
  • Fax: 253-931-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60790547
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60790547
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00156782
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2090830
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: