Provider Demographics
NPI:1659479731
Name:RATCLIFFE, MARIJO MILLER (ARNP)
Entity type:Individual
Prefix:
First Name:MARIJO
Middle Name:MILLER
Last Name:RATCLIFFE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAND POINT WAY NE
Mailing Address - Street 2:A5937
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3901
Mailing Address - Country:US
Mailing Address - Phone:206-987-5164
Mailing Address - Fax:206-987-2639
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:A5937
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2174
Practice Address - Fax:206-987-2639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005186363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9627951Medicaid
P96838Medicare UPIN
NOT AVAILABLEMedicare ID - Type Unspecified