Healthcare Provider Details

I. General information

NPI: 1245294602
Provider Name (Legal Business Name): RENEE AMELIA WALDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 QUICK RD
CASTLE ROCK WA
98611-9324
US

IV. Provider business mailing address

560 QUICK RD
CASTLE ROCK WA
98611-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-274-6150
  • Fax:
Mailing address:
  • Phone: 360-274-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAP30005004
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number08201297N3
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: