Healthcare Provider Details

I. General information

NPI: 1053822767
Provider Name (Legal Business Name): EMILY ANN SPECA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

9103B ROOSEVELT WAY NE
SEATTLE WA
98115-2864
US

V. Phone/Fax

Practice location:
  • Phone: 888-862-2737
  • Fax:
Mailing address:
  • Phone: 812-457-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60221949
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60764588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: