Healthcare Provider Details

I. General information

NPI: 1104936020
Provider Name (Legal Business Name): REBECCA STICKLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 530
RENTON WA
98055-5700
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-6076
  • Fax: 425-226-5224
Mailing address:
  • Phone: 425-656-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG79112
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD 18482
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD 60404605
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: