Healthcare Provider Details

I. General information

NPI: 1467225441
Provider Name (Legal Business Name): DEGRATE., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 N 40TH ST
TACOMA WA
98407-3629
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE 5312
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 503-997-8966
  • Fax:
Mailing address:
  • Phone: 971-379-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RITA J. DEGRATE
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 971-379-3690