Individual
KIVA C FALLGATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2930 MAPLE ST, EVERETT, WA 98201-3832
(425) 261-1500
Mailing address
2930 MAPLE ST, EVERETT, WA 98201-3832
(425) 261-1500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5216
AZ
363A00000X
Physician Assistant
Primary
60385339
WA
Other
Enumeration date
09/10/2012
Last updated
06/08/2021
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