Provider Demographics
NPI:1326519968
Name:CHAGOLLA, RICCA (RN)
Entity Type:Individual
Prefix:
First Name:RICCA
Middle Name:
Last Name:CHAGOLLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28900 124TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3101
Mailing Address - Country:US
Mailing Address - Phone:253-804-4539
Mailing Address - Fax:253-876-2507
Practice Address - Street 1:28900 124TH AVE SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-3101
Practice Address - Country:US
Practice Address - Phone:253-804-4539
Practice Address - Fax:253-876-2507
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60797261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse