Healthcare Provider Details

I. General information

NPI: 1174931042
Provider Name (Legal Business Name): REBECCA MASS-KRAJEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16329 NE 80TH ST
REDMOND WA
98052-3820
US

IV. Provider business mailing address

16152 NE 112TH ST
REDMOND WA
98052-2666
US

V. Phone/Fax

Practice location:
  • Phone: 425-610-8030
  • Fax:
Mailing address:
  • Phone: 206-612-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60099600
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60492406
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: