Healthcare Provider Details

I. General information

NPI: 1700958493
Provider Name (Legal Business Name): PETRINA E GAVRILIS RN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SE WASHINGTON ST.
PULLMAN WA
99164
US

IV. Provider business mailing address

PO BOX 642302
PULLMAN WA
99164-2302
US

V. Phone/Fax

Practice location:
  • Phone: 509-335-3575
  • Fax: 509-335-6223
Mailing address:
  • Phone: 509-335-3575
  • Fax: 509-335-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60410653
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: