Provider Demographics
NPI:1629405238
Name:DEBOLT-RICHINS, GAYLE JANETTE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:JANETTE
Last Name:DEBOLT-RICHINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3008
Mailing Address - Country:US
Mailing Address - Phone:206-612-0070
Mailing Address - Fax:
Practice Address - Street 1:720 6TH AVE N
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3008
Practice Address - Country:US
Practice Address - Phone:206-612-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60416172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily