Provider Demographics
NPI:1811153414
Name:PUSATERI, ROWENA N (MD)
Entity type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:N
Last Name:PUSATERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROWENA
Other - Middle Name:BONOT
Other - Last Name:NARVADEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E. KINCAID STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-428-2500
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:1400 E. KINCAID STREET
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4127
Practice Address - Country:US
Practice Address - Phone:360-428-2580
Practice Address - Fax:360-428-6493
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60078780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA263820OtherLABOR & INDUSTRIES
WA8892568Medicare PIN