State revokes, suspends licenses, certifications, registrations of health care providers

For immediate release: May 20, 2024   (24-055)

Contact: DOH Communications
Public inquiries: Health Systems Customer Service 360-236-4700

OLYMPIA -- The Washington State Department of Health has revoked or suspended the licenses, certifications, or registrations of the following health care providers in our state. The department has also immediately suspended the credentials of people who have been prohibited from practicing in other states.

The department’s Health Systems Quality Assurance Division works with boards, commissions and advisory committees to set licensing standards for more than 80 health care professions (e.g., dentists, nurses, counselors). Information about disciplinary action taken against medical doctors and physician assistants can be found on the Washington Medical Commission (WMC) website. Questions about WMC disciplinary actions can be sent to

Information about health care providers is on the agency’s website. Click on “Health Care Provider Lookup” under the “Find it Fast” section of the Department of Health website ( The site includes information about a health care provider’s license status, the expiration and renewal date of their credential, disciplinary actions and copies of legal documents issued after July 1998. This information is also available by calling 360-236-4700. Consumers who think a health care provider acted unprofessionally are also encouraged to call and report their complaint.

Benton County

In April 2024 the Board of Nursing (formerly the Nursing Commission) and Tyler Waite (RN61072301) agreed to the suspension of his registered nurse license. Prior to reinstatement, Waite must undergo a psychiatric or psychological evaluation. In February 2023, Waite was convicted of first-degree animal abuse, in the Washington County Circuit Court, state of Oregon.

Skagit County

In April 2024 the Board of Osteopathic Medicine and Surgery and Larri A. Mishko (OP00001626) agreed to the indefinite suspension of her osteopathic physician and surgeon license. Prior to petitioning for reinstatement, Mishko must re-enter a monitoring program and comply with the monitoring program’s requirements. In October 2021, Mishko enrolled in a five-year monitoring agreement with a substance use monitoring program. In February 2022, Mishko allegedly failed to comply with treatment recommendations and was discharged from the program in March 2023.

Snohomish County

In April 2024 the secretary of health indefinitely suspended the home care aide license of Romulo Ramos De Guzman (HM61053327). Prior to petitioning for reinstatement, De Guzman must provide a response to the letter of cooperation. In December 2023, De Guzman failed to respond to the letter of cooperation regarding complaints of sexual misconduct of two patients in an assisted-living facility.

Spokane County

In April 2024 the Dental Quality Assurance Commission indefinitely suspended the dentist license of Sandy Fletcher Montano (DE60486669). Prior to petitioning for reinstatement, Montano must complete a mental and physical examination. In November 2021, Montano violated multiple sanitation and infection control requirements.

Out of State

California: In April 2024 the Board of Nursing (formerly the Nursing Commission) indefinitely suspended the registered nurse license of Pam R. Nelson (RN60218246). Prior to petitioning for reinstatement, Nelson must contact a monitoring program and, if required, enroll in the monitoring program. In September 2023, the Arizona State Board of Nursing accepted the voluntary surrender of Nelson’s registered nurse license based on findings to include Nelson’s July 2023 voluntary surrender of her registered nurse license in the state of Oregon.

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