Provider Demographics
NPI:1609057231
Name:GERMAINE D'ANNIBALLE
Entity Type:Organization
Organization Name:GERMAINE D'ANNIBALLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:GERMAINE
Authorized Official - Last Name:D'ANNIBALLE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-390-7186
Mailing Address - Street 1:2719 E MADISON ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4752
Mailing Address - Country:US
Mailing Address - Phone:206-390-7186
Mailing Address - Fax:206-329-0409
Practice Address - Street 1:2719 E MADISON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-390-7186
Practice Address - Fax:206-329-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003636364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB14881Medicare PIN
WAPO4789Medicare UPIN