Individual
GEORGIANNA NICOLE VASILAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
34509 9TH AVE S STE 204, FEDERAL WAY, WA 98003-8708
(538) 355-5102
(253) 835-5511
Mailing address
34509 9TH AVE S STE 204, FEDERAL WAY, WA 98003-8708
(538) 355-5102
(253) 835-5511
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
55210
CA
363A00000X
Physician Assistant
Primary
PA60921113
WA
363AS0400X
Surgical Physician Assistant
PA60921113
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2166472
—
WA
Enumeration date
04/18/2017
Last updated
11/22/2021
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