Provider Demographics
NPI:1437201126
Name:RATTAZZI, EMMA GRACE (ARNP, CNM)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:GRACE
Last Name:RATTAZZI
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:MRS
Other - First Name:EMMA
Other - Middle Name:GENSERT
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:2195 NW SHEVLIN PARK RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7102
Practice Address - Country:US
Practice Address - Phone:541-706-3843
Practice Address - Fax:541-278-8375
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60282825363L00000X, 363LP1700X
OR202210296NP-PP363LF0000X
WARN60282824163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1437201126Medicaid