Healthcare Provider Details

I. General information

NPI: 1376625590
Provider Name (Legal Business Name): PATRICE MARIE VAN DUINE ARNP, M.ED, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICE MARIE BORER ARNP

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 COLBY AVE. STE #328
EVERETT WA
98201-3557
US

IV. Provider business mailing address

2722 COLBY AVE STE 328
EVERETT WA
98201-3531
US

V. Phone/Fax

Practice location:
  • Phone: 425-740-3600
  • Fax: 425-740-3601
Mailing address:
  • Phone: 425-740-3600
  • Fax: 425-740-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30007518
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN00059378
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN00059378
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00059378
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: