Provider Demographics
NPI:1720222821
Name:JANNOTTA, GEMI ESTELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:GEMI
Middle Name:ESTELLE
Last Name:JANNOTTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GEMI
Other - Middle Name:ESTELLE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:204-543-6420
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:904-744-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60737804363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA125029766BMedicaid
WA1720222821Medicaid
FL0009909-00Medicaid
GA125029766BMedicaid
FLBR251YMedicare PIN