Provider Demographics
NPI:1205885290
Name:SAVATINI, KATHY LUCIA (PA C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LUCIA
Last Name:SAVATINI
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-0368
Mailing Address - Country:US
Mailing Address - Phone:360-491-4211
Mailing Address - Fax:360-491-6328
Practice Address - Street 1:615 LILLY RD NE
Practice Address - Street 2:STE 100
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-491-4211
Practice Address - Fax:360-491-6328
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003467363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8253171Medicaid
WA153393OtherLABOR & INDUSTRIES
WA8253171Medicaid
AB27345Medicare PIN