Healthcare Provider Details

I. General information

NPI: 1710045778
Provider Name (Legal Business Name): MARTA LEE KRISSOVICH ANP-BC, CWOCN-AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTA L. PATMAS RN, MSN, CCCN

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SUNSET BLVD
PORT TOWNSEND WA
98368-8913
US

IV. Provider business mailing address

151 SUNSET BLVD
PORT TOWNSEND WA
98368-8913
US

V. Phone/Fax

Practice location:
  • Phone: 360-316-6306
  • Fax:
Mailing address:
  • Phone: 360-316-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberN260535011
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN60533319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: