Provider Demographics
NPI:1417306127
Name:RAFFAELE, VIRGINIA MARIA (PA-C, CD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIA
Last Name:RAFFAELE
Suffix:
Gender:F
Credentials:PA-C, CD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:M
Other - Last Name:VERAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2930 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3832
Mailing Address - Country:US
Mailing Address - Phone:425-261-1500
Mailing Address - Fax:
Practice Address - Street 1:2930 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3832
Practice Address - Country:US
Practice Address - Phone:425-261-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60827984363A00000X
WA14122374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant