Healthcare Provider Details

I. General information

NPI: 1265050108
Provider Name (Legal Business Name): VEDIKA RAMACHANDRAN IYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 E YESLER WAY STE 150
SEATTLE WA
98122-5959
US

IV. Provider business mailing address

1107 LAKE WASHINGTON BLVD
SEATTLE WA
98122-3529
US

V. Phone/Fax

Practice location:
  • Phone: 206-299-1900
  • Fax:
Mailing address:
  • Phone: 510-371-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61319347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: