Healthcare Provider Details

I. General information

NPI: 1609932508
Provider Name (Legal Business Name): SALLY LOVELLE AVENSON ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 6TH AVE NE
SEATTLE WA
98115-4130
US

IV. Provider business mailing address

7602 6TH AVE NE
SEATTLE WA
98115-4130
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-8773
  • Fax: 206-517-4224
Mailing address:
  • Phone: 206-527-8773
  • Fax: 206-517-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN00052841
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP30000503
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: