Healthcare Provider Details

I. General information

NPI: 1538282165
Provider Name (Legal Business Name): CALLIE ANNE REGER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S 336TH ST STE C
FEDERAL WAY WA
98003-6329
US

IV. Provider business mailing address

PO BOX 26730
FEDERAL WAY WA
98093-3730
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-1700
  • Fax: 253-661-4565
Mailing address:
  • Phone: 253-661-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007553
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00160978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: