Provider Demographics
NPI:1437820164
Name:GOETTL, AUDREY ANN (RN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ANN
Last Name:GOETTL
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 1:500 19TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4072
Mailing Address - Country:US
Mailing Address - Phone:206-299-1667
Mailing Address - Fax:206-299-1608
Practice Address - Street 1:500 19TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4072
Practice Address - Country:US
Practice Address - Phone:206-299-1667
Practice Address - Fax:206-299-1608
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60970555163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care