Provider Demographics
NPI:1245302637
Name:BANTOLINO, YOLANDA ABEN (MD, PA)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ABEN
Last Name:BANTOLINO
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 S MEAD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-2981
Mailing Address - Country:US
Mailing Address - Phone:206-744-2446
Mailing Address - Fax:206-744-8781
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:MAILBOX 359777
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-3590
Practice Address - Fax:206-744-8781
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS95717Medicare UPIN