Provider Demographics
NPI:1619538683
Name:ROMERO, GABRIELLA NICOLE (PA-C, MSPAS)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:NICOLE
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PA-C, MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SE 164TH AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-940-0810
Mailing Address - Fax:360-597-3436
Practice Address - Street 1:1700 116TH AVE NE
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-209-0840
Practice Address - Fax:425-209-0778
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA60972448207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant