Provider Demographics
NPI:1871181370
Name:KHAN, ANASTASIA (RN)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:DEE
Other - Last Name:CACABELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2701 RIGNEY RD APT F11
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-2833
Mailing Address - Country:US
Mailing Address - Phone:253-905-7773
Mailing Address - Fax:
Practice Address - Street 1:9400 GRAVELLY LAKE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1512
Practice Address - Country:US
Practice Address - Phone:253-584-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60023168163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency