Healthcare Provider Details

I. General information

NPI: 1942197603
Provider Name (Legal Business Name): SYDNEY BEWERNICK APRN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 4TH AVE NW UNIT 303
ISSAQUAH WA
98027-9371
US

IV. Provider business mailing address

102 E 5TH ST
NORTH BEND WA
98045-8263
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-4768
  • Fax:
Mailing address:
  • Phone: 480-329-8819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61051351
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: