Healthcare Provider Details

I. General information

NPI: 1306861000
Provider Name (Legal Business Name): REBEKAH COUPER-NOLES CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 PACIFIC AVE 7TH FLOOR
EVERETT WA
98201-4147
US

IV. Provider business mailing address

909 N BROADWAY PBO
EVERETT WA
98201-1409
US

V. Phone/Fax

Practice location:
  • Phone: 425-303-6500
  • Fax: 425-303-6550
Mailing address:
  • Phone: 425-317-0699
  • Fax: 425-317-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00146048
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006725
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30006725
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: