Healthcare Provider Details

I. General information

NPI: 1710407390
Provider Name (Legal Business Name): PATTI LYNN FENTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13030 121ST WAY NE STE 202
KIRKLAND WA
98034-3008
US

IV. Provider business mailing address

13030 121ST WAY NE STE 202
KIRKLAND WA
98034-3008
US

V. Phone/Fax

Practice location:
  • Phone: 206-263-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00059211
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: