Basic Information
Provider Information
NPI: 1306458328
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOSKINS-DORSEY
FirstName: GENEVA
MiddleName: PAULA
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 48134
Address2:  
City: SEATTLE
State: WA
PostalCode: 98148
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 11120 NE 33RD PLACE
Address2: SUITE 202
City: BELLEVUE
State: WA
PostalCode: 98004
CountryCode: US
TelephoneNumber: 2068231004
FaxNumber: 2063093319
Other Information
ProviderEnumerationDate: 08/20/2020
LastUpdateDate: 08/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XRN60440532WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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