Healthcare Provider Details

I. General information

NPI: 1922393784
Provider Name (Legal Business Name): ROBYN LEE SEABURG-ODLAUG CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 NE 10TH ST
BELLEVUE WA
98004-8578
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-3000
  • Fax:
Mailing address:
  • Phone: 206-543-6420
  • Fax: 206-520-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60262026
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: