Provider Demographics
NPI:1790294254
Name:ESTRADA, ANNIE E (RN)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:E
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:E
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:21504 50TH AVE W APT C5
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3363
Mailing Address - Country:US
Mailing Address - Phone:210-865-0226
Mailing Address - Fax:
Practice Address - Street 1:21603 84TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7818
Practice Address - Country:US
Practice Address - Phone:425-431-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN260385462163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool