Healthcare Provider Details

I. General information

NPI: 1124852645
Provider Name (Legal Business Name): JUSTIN RIGOLOSO ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15833 MILL CREEK BLVD # 12010
MILL CREEK WA
98012-1200
US

IV. Provider business mailing address

11623 40TH DR SE
EVERETT WA
98208-5330
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-0212
  • Fax:
Mailing address:
  • Phone: 334-790-9336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP61450938
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: