Healthcare Provider Details

I. General information

NPI: 1720817281
Provider Name (Legal Business Name): SOGOL SEDGHI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 112TH AVE NE STE 100
BELLEVUE WA
98004-4509
US

IV. Provider business mailing address

1110 112TH AVE NE STE 100
BELLEVUE WA
98004-4509
US

V. Phone/Fax

Practice location:
  • Phone: 425-688-8675
  • Fax: 425-688-8111
Mailing address:
  • Phone: 425-688-8675
  • Fax: 425-688-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61591509
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: