Healthcare Provider Details

I. General information

NPI: 1295359206
Provider Name (Legal Business Name): JESSICA MAE RYDELSKI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N 10TH ST STE A
RENTON WA
98057-5577
US

IV. Provider business mailing address

1205 N 10TH ST STE A
RENTON WA
98057-5577
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3475
  • Fax: 425-690-9475
Mailing address:
  • Phone: 425-690-3475
  • Fax: 425-690-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61048379
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61048379
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: