Provider Demographics
NPI:1689654758
Name:IWAMOTO, MARIANNE MILLER (ARNP, C-FNP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MILLER
Last Name:IWAMOTO
Suffix:
Gender:F
Credentials:ARNP, C-FNP
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:M
Other - Last Name:IWAMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:17254 140TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-7014
Mailing Address - Country:US
Mailing Address - Phone:425-226-7614
Mailing Address - Fax:
Practice Address - Street 1:17254 140TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-7014
Practice Address - Country:US
Practice Address - Phone:425-226-7614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8873840Medicare UPIN
WA8858431Medicare UPIN