MEDICARE: SILVIA TINA FRADKIN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP30000733	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8853847	OTHER	WA	PIN

General Provider Information

NPI Number	:	1083612279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SILVIA TINA FRADKIN ARNP

Provider Business Mailing Address
First Line	:	6512 20TH STREET CT W STE C
Second Line	:
City	:	FIRCREST
State	:	WA
Zip	:	98466-6212
Country	:	US
Telephone Number	:	253-459-0295
Fax Number	:	253-565-5899

Provider Business Practice Location Address
First Line	:	6512 20TH STREET CT W
Second Line	:	SUITE C
City	:	FIRCREST
State	:	WA
Zip	:	98466-6212
Country	:	US
Telephone Number	:	253-459-0295
Fax Number	:	253-565-5899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/18/2007

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