=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043348006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVA FAYE DEE HIATT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 05/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4957 LAKEMONT BLVD SUITE C-4 BOX #202
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-746-7068
-----------------------------------------------------
Fax | 425-649-2057
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16720 SE 271ST ST SUITE 202
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98042-7342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-631-2380
-----------------------------------------------------
Fax | 425-649-2057
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRACTIONER
-----------------------------------------------------
Name | MRS. EVA FAYE DEE HIATT
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 253-631-2380
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | AP30004647
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------