Basic Information
| Provider Information | |||||||||
| NPI: | 1700055795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | ROYAL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9021 169TH ST E | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983752259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534466798 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11102 SUNRISE BLVD. E., STE. 103 | ||||||||
| Address2: | WOODCREEK HEALTHCARE | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538488797 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | RN00148862 | WA | N | Nursing Service Providers | Registered Nurse | Home Health | 363LF0000X | AP60432813 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RN00148862 | 01 | WA | HEALTH PROFESSIONS QA DIV | OTHER | AP60432813 | 01 | WA | DSHS | OTHER |