Healthcare Provider Details

I. General information

NPI: 1023500386
Provider Name (Legal Business Name): MIGUEL ANTONIO ARTEAGA RN, MN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 06/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

IV. Provider business mailing address

1124 NE TAFTSON ST.
OAK HARBOR WA
98277-4856
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4511
  • Fax: 360-716-5782
Mailing address:
  • Phone: 360-679-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00145870
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN00145870
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: