Provider Demographics
NPI:1326504457
Name:PATTENGALE, ASHLEY (ARNP, FNP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PATTENGALE
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 S I ST STE 204
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5092
Mailing Address - Country:US
Mailing Address - Phone:253-752-8882
Mailing Address - Fax:253-590-0260
Practice Address - Street 1:1624 S I ST STE 204
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5092
Practice Address - Country:US
Practice Address - Phone:253-752-8882
Practice Address - Fax:253-590-0260
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61111203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2211125Medicaid