Provider Demographics
NPI:1588670020
Name:NAVARRO, AGNES L (PA)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:L
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 359868
Mailing Address - Street 2:325 9TH AVE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-3205
Mailing Address - Fax:206-744-5194
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2499
Practice Address - Country:US
Practice Address - Phone:206-744-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001525363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0197287OtherL&I PIN
WA5874NAOtherREGENCE BLUE SHIELD PIN
WA84624UOtherREGENCE BLUE SHIELD PIN
WA8326035Medicaid
WAAB24257Medicare PIN
P40437Medicare UPIN
WA5874NAOtherREGENCE BLUE SHIELD PIN
WAG8878990Medicare PIN