Healthcare Provider Details

I. General information

NPI: 1720389075
Provider Name (Legal Business Name): AMY LAUREN BRYCE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 3RD AVE SW
SEATTLE WA
98146-2949
US

IV. Provider business mailing address

12460 3RD AVE SW
SEATTLE WA
98146-2949
US

V. Phone/Fax

Practice location:
  • Phone: 541-962-5027
  • Fax:
Mailing address:
  • Phone: 541-962-5027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60459722
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60459723
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: