Healthcare Provider Details

I. General information

NPI: 1467705921
Provider Name (Legal Business Name): MIRELA ELENA GOETZKE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 500
RENTON WA
98055-5782
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3482
  • Fax: 425-690-9082
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number778539
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP0764780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: