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General NPI Number Information
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NPI Number | 1710872718
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Entity Type | Individual
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Provider Name | DESIRAE TARGARYEN RN
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 7224 PACIFIC HWY E
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City | MILTON
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State | WA
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Zip | 98354-9654
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Country | US
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Telephone | 310-623-9366
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Fax |
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Provider Business Mailing Address
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Address Line | 1379 BELLEVUE WAY NE APT A
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City | BELLEVUE
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State | WA
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Zip | 98004-3694
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Country | US
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Telephone | 310-623-9366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 61026712
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License Number State | WA
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