Provider Demographics
NPI:1932598778
Name:RUBRITZ, GEORGIE
Entity Type:Individual
Prefix:
First Name:GEORGIE
Middle Name:
Last Name:RUBRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 NE 72ND DR STE 9-75
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7300
Mailing Address - Country:US
Mailing Address - Phone:360-831-3960
Mailing Address - Fax:360-546-2790
Practice Address - Street 1:8910 NE ST JOHNS RD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9221
Practice Address - Country:US
Practice Address - Phone:360-831-3960
Practice Address - Fax:360-546-2790
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60085560376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113741OtherDOMAIN