Healthcare Provider Details

I. General information

NPI: 1124965025
Provider Name (Legal Business Name): AMELIA LEE QUATERMASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 13TH ST
EVERETT WA
98201-1689
US

IV. Provider business mailing address

7510 ROOSEVELT WAY NE APT 4
SEATTLE WA
98115-4240
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-2000
  • Fax:
Mailing address:
  • Phone: 503-970-0011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN60992535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: