Healthcare Provider Details

I. General information

NPI: 1134374887
Provider Name (Legal Business Name): MARTHA ANNE CARLSTEAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE DEPARTMENT OF ANESTHESIA
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6604
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00107399
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number274727
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60067551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: