Healthcare Provider Details

I. General information

NPI: 1700797651
Provider Name (Legal Business Name): CALLIE SUE PATINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18244 BLUEBERRY LN
MONROE WA
98272-1313
US

IV. Provider business mailing address

PO BOX 868
MONROE WA
98272-0868
US

V. Phone/Fax

Practice location:
  • Phone: 206-334-7129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBDC.BD.70174755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: