Provider Demographics
NPI:1437394970
Name:WALCOTT, PATRICIA LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:HENDRICKS
Other - Last Name:WALCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1515 128TH DR NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9249
Mailing Address - Country:US
Mailing Address - Phone:425-231-5351
Mailing Address - Fax:
Practice Address - Street 1:3020 RUCKER AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3900
Practice Address - Country:US
Practice Address - Phone:425-339-5220
Practice Address - Fax:425-339-5222
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00059563163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse