Provider Demographics
NPI:1073580684
Name:MERENDA, PATRICIA (ARNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MERENDA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:FORG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:16259 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3049
Mailing Address - Country:US
Mailing Address - Phone:206-931-1357
Mailing Address - Fax:
Practice Address - Street 1:16259 SYLVESTER RD SW
Practice Address - Street 2:SUITE 401
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3049
Practice Address - Country:US
Practice Address - Phone:206-242-8837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006759363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9644048Medicaid
WA9644048Medicaid
WAQ41167Medicare UPIN