Provider Demographics
NPI:1417085390
Name:HIATT, EVAFAYE DEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:EVAFAYE
Middle Name:DEE
Last Name:HIATT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:16720 SE 271ST ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-7342
Practice Address - Country:US
Practice Address - Phone:253-631-2380
Practice Address - Fax:425-649-2057
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9472HIOtherREGENCE
WA0007644478OtherAETNA
WA0001133372OtherMHN
WAA944372OtherUPS
WA156388100000OtherPREMERA
WA9472HIOtherREGENCE
WAG8808467Medicare PIN