Healthcare Provider Details

I. General information

NPI: 1811486228
Provider Name (Legal Business Name): GREGORY IMAFIDON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 2ND PL N STE 11-103
KENT WA
98032-4537
US

IV. Provider business mailing address

521 2ND PL N STE 11-103
KENT WA
98032-4537
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3491
  • Fax: 425-690-9091
Mailing address:
  • Phone: 425-690-3491
  • Fax: 425-690-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61288019
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137759
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04180510
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61288019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: