Provider Demographics
NPI:1629676119
Name:WYATT, ROBERT J (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:WYATT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 STATE ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3251
Mailing Address - Country:US
Mailing Address - Phone:425-879-7698
Mailing Address - Fax:
Practice Address - Street 1:1700 AIRPORT WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1618
Practice Address - Country:US
Practice Address - Phone:206-223-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00127169163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse