Provider Demographics
NPI:1659702058
Name:HINKULOW, MARICEL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARICEL
Middle Name:
Last Name:HINKULOW
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 1:16224 SE 138TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-6837
Mailing Address - Country:US
Mailing Address - Phone:425-970-5373
Mailing Address - Fax:425-528-2546
Practice Address - Street 1:16224 SE 138TH PL
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-6837
Practice Address - Country:US
Practice Address - Phone:425-970-5373
Practice Address - Fax:425-528-2546
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60428735363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035601Medicaid
WA2035601Medicaid