MEDICARE: MR. GABE RAPHAEL WORTMAN 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	363LF0000X	Family Nurse Practitioner	AP61598757	WA
2	363L00000X	Nurse Practitioner	AP61598757	WA

General Provider Information

NPI Number	:	1386476026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GABE RAPHAEL WORTMAN ARNP

Provider Business Mailing Address
First Line	:	PO BOX 34703
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1703
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6884 HANNEGAN RD
Second Line	:
City	:	EVERSON
State	:	WA
Zip	:	98247-9637
Country	:	US
Telephone Number	:	360-354-0766
Fax Number	:	360-354-7667

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

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	11/13/2025

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