Provider Demographics
NPI:1710407390
Name:FENTON, PATTI LYNN (RN)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LYNN
Last Name:FENTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13030 121ST WAY NE STE 202
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13030 121ST WAY NE STE 202
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3008
Practice Address - Country:US
Practice Address - Phone:206-263-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00059211163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty