Provider Demographics
NPI:1083612279
Name:FRADKIN, SILVIA TINA (ARNP)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:TINA
Last Name:FRADKIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 20TH STREET CT W STE C
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6212
Mailing Address - Country:US
Mailing Address - Phone:253-459-0295
Mailing Address - Fax:253-565-5899
Practice Address - Street 1:6512 20TH STREET CT W
Practice Address - Street 2:SUITE C
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6212
Practice Address - Country:US
Practice Address - Phone:253-459-0295
Practice Address - Fax:253-565-5899
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000733363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8853847OtherPIN
WAQ45390Medicare UPIN