Provider Demographics
NPI:1033755699
Name:JALILI, MARYAM ROYA (DNP ARNP)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:ROYA
Last Name:JALILI
Suffix:
Gender:F
Credentials:DNP ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 JAMES ST UNIT 310
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2493
Mailing Address - Country:US
Mailing Address - Phone:206-790-6427
Mailing Address - Fax:
Practice Address - Street 1:1812 S MILDRED ST STE H
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1634
Practice Address - Country:US
Practice Address - Phone:253-316-8442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61170286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty