Provider Demographics
NPI:1922635887
Name:CASCADE NURSE PRACTITIONERS
Entity Type:Organization
Organization Name:CASCADE NURSE PRACTITIONERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-387-2469
Mailing Address - Street 1:5409 100TH ST SW UNIT 39800
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-0970
Mailing Address - Country:US
Mailing Address - Phone:253-576-8832
Mailing Address - Fax:877-682-9319
Practice Address - Street 1:5409 100TH ST SW UNIT 39800
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98496-0970
Practice Address - Country:US
Practice Address - Phone:253-549-8576
Practice Address - Fax:877-682-9319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty