Provider Demographics
NPI:1649723198
Name:FITZPATRICK, MARTHA A (APNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APNP
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 260
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-835-7400
Mailing Address - Fax:206-835-7439
Practice Address - Street 1:16233 SYLVESTER RD SW STE 260
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-835-7400
Practice Address - Fax:206-835-7439
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7138363L00000X
WAAP60811877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2093360Medicaid