Healthcare Provider Details

I. General information

NPI: 1225539158
Provider Name (Legal Business Name): MAYA GABRIELLE GOLAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S OB.8.412
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371
SEATTLE WA
98145-5005
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2114
  • Fax: 206-987-2651
Mailing address:
  • Phone: 206-987-2114
  • Fax: 206-987-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60742851
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60755367
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: