Provider Demographics
NPI:1366911679
Name:PAPOFF-WALLACE, ADRIANNE (ARNP)
Entity type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:
Last Name:PAPOFF-WALLACE
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 1:3203 WILTON LN E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2315
Mailing Address - Country:US
Mailing Address - Phone:253-533-5768
Mailing Address - Fax:866-638-7530
Practice Address - Street 1:3203 WILTON LN E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2315
Practice Address - Country:US
Practice Address - Phone:253-533-5768
Practice Address - Fax:866-638-7530
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61173244363LP0808X
WARN60618226163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health