Healthcare Provider Details

I. General information

NPI: 1831271485
Provider Name (Legal Business Name): AMY NICOLE ADKINS-DWIVEDI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 166TH AVE NE 202
REDMOND WA
98052-3999
US

IV. Provider business mailing address

17256 NE 18TH PL
BELLEVUE WA
98008-3141
US

V. Phone/Fax

Practice location:
  • Phone: 425-941-9540
  • Fax: 425-633-2281
Mailing address:
  • Phone: 513-257-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 307054
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP-08943
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP60228488
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: