Healthcare Provider Details

I. General information

NPI: 1144873324
Provider Name (Legal Business Name): BERNICE FRANCESCA WANTA REBUTIACO DNP, ARNP, AGNPC-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

IV. Provider business mailing address

16251 SYLVESTER RD SW
BURIEN WA
98166-3017
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6341
  • Fax: 253-426-6344
Mailing address:
  • Phone: 253-426-6341
  • Fax: 253-426-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61294991
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61294991
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60654280
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60654280
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: