Basic Information
Provider Information | |||||||||
NPI: | 1013262617 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SLOTHOUBER GILES | ||||||||
FirstName: | FRANSJE | ||||||||
MiddleName: | JEREONTJE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DNP, NP-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SLOTHOUBER | ||||||||
OtherFirstName: | FRANSJE | ||||||||
OtherMiddleName: | JEROENTJE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2901 BRIDGEPORT WAY W | ||||||||
Address2: |   | ||||||||
City: | UNIVERSITY PLACE | ||||||||
State: | WA | ||||||||
PostalCode: | 984664614 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535347000 | ||||||||
FaxNumber: | 2536276576 | ||||||||
Practice Location | |||||||||
Address1: | 2901 BRIDGEPORT WAY W | ||||||||
Address2: |   | ||||||||
City: | UNIVERSITY PLACE | ||||||||
State: | WA | ||||||||
PostalCode: | 984664614 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535347000 | ||||||||
FaxNumber: | 2536276576 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/19/2012 | ||||||||
LastUpdateDate: | 12/09/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/09/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP60686034 | WA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LF0000X | AP60686034 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 2072740 | 05 | WA |   | MEDICAID |