Provider Demographics
NPI: | 1932434222 |
---|---|
Name: | SAUNAR, MARITESS AURELIO (CNP) |
Entity Type: | Individual |
Prefix: | MISS |
First Name: | MARITESS |
Middle Name: | AURELIO |
Last Name: | SAUNAR |
Suffix: | |
Gender: | F |
Credentials: | CNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1717 S J ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98405-4933 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-426-6341 |
Mailing Address - Fax: | 253-426-6344 |
Practice Address - Street 1: | 1717 S J ST |
Practice Address - Street 2: | |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-4933 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-426-6341 |
Practice Address - Fax: | 253-426-6344 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-10-05 |
Last Update Date: | 2020-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | AP60678139 | 363L00000X, 363LA2200X |
IL | 209007721 | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 2073843 | Medicaid |