Provider Demographics
NPI:1043348006
Name:EVA FAYE DEE HIATT
Entity Type:Organization
Organization Name:EVA FAYE DEE HIATT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRACTIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA FAYE
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-631-2380
Mailing Address - Street 1:16720 SE 271ST ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-7342
Mailing Address - Country:US
Mailing Address - Phone:253-631-2380
Mailing Address - Fax:425-649-2057
Practice Address - Street 1:4957 LAKEMONT BLVD
Practice Address - Street 2:SUITE C-4 BOX #202
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-746-7068
Practice Address - Fax:425-649-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0001133372OtherMHN
WA156388100000OtherPREMERA
WAA944372OtherUPS
WA00076444478OtherAETNA
WA9472HIOtherREGENCE
WA=========AAOtherUNIFORM
WA156388100000OtherPREMERA
WAA944372OtherUPS