Healthcare Provider Details

I. General information

NPI: 1073204483
Provider Name (Legal Business Name): CIARA GEDDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 59TH AVE SW
LAKEWOOD WA
98499-2858
US

IV. Provider business mailing address

5370 LITTLE MEADOW CT
PARKER CO
80134-4542
US

V. Phone/Fax

Practice location:
  • Phone: 253-581-7020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61373121
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: