Healthcare Provider Details

I. General information

NPI: 1508798661
Provider Name (Legal Business Name): REBECCA ANN NOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN STE 420
KIRKLAND WA
98034-3042
US

IV. Provider business mailing address

6639 137TH PL NE APT 424
REDMOND WA
98052-9536
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-6400
  • Fax:
Mailing address:
  • Phone: 717-951-5895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP.AP.70140235
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN61473694
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: