Provider Demographics
NPI:1982294070
Name:GATATA, EDWIN (RN)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:GATATA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38005 39TH AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-8784
Mailing Address - Country:US
Mailing Address - Phone:206-458-0283
Mailing Address - Fax:
Practice Address - Street 1:38005 39TH AVE S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-8784
Practice Address - Country:US
Practice Address - Phone:206-458-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60193900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse