Provider Demographics
NPI:1265240857
Name:CERBITO, ANA DOMINIQUE (RN)
Entity type:Individual
Prefix:
First Name:ANA DOMINIQUE
Middle Name:
Last Name:CERBITO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18718 OCCIDENTAL AVE S
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2050
Mailing Address - Country:US
Mailing Address - Phone:206-478-9521
Mailing Address - Fax:
Practice Address - Street 1:3320 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1805
Practice Address - Country:US
Practice Address - Phone:253-999-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61422242163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse