Healthcare Provider Details

I. General information

NPI: 1790384451
Provider Name (Legal Business Name): GHEA MAE TIPING DEGILLO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNION AVE SE STE 200
OLYMPIA WA
98501-2060
US

IV. Provider business mailing address

400 UNION AVE SE STE 200
OLYMPIA WA
98501-2060
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0997474
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: