Healthcare Provider Details

I. General information

NPI: 1801394341
Provider Name (Legal Business Name): DR. RUTH FREEMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 201ST PL SE STE 100
BOTHELL WA
98012
US

IV. Provider business mailing address

1908 201ST PL SE STE 100
BOTHELL WA
98012-8572
US

V. Phone/Fax

Practice location:
  • Phone: 425-219-4720
  • Fax: 425-949-7059
Mailing address:
  • Phone: 425-219-4720
  • Fax: 425-949-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8234890
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: MISS SARA ELIZABETH PEDERSEN
Title or Position: DIRECTOR, CLINICAL SERVICES
Credential:
Phone: 425-219-4720