Provider Demographics
NPI:1588854483
Name:ADVANCED PRACTICE GERIATRICS, LLC
Entity Type:Organization
Organization Name:ADVANCED PRACTICE GERIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HYATT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:360-335-1700
Mailing Address - Street 1:PO BOX 1293
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-0928
Mailing Address - Country:US
Mailing Address - Phone:360-335-1700
Mailing Address - Fax:
Practice Address - Street 1:38324 SE HIDDEN FALLS ROAD
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671
Practice Address - Country:US
Practice Address - Phone:360-335-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty