Provider Demographics
NPI:1972581387
Name:AFLATOONI, ROBERTA Y (MN ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:Y
Last Name:AFLATOONI
Suffix:
Gender:F
Credentials:MN ARNP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:Y
Other - Last Name:CARMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5421
Mailing Address - Fax:425-317-3975
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5421
Practice Address - Fax:425-317-3975
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007171207RG0100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9647413Medicaid
WA8858169Medicare PIN
WA9647413Medicaid