Healthcare Provider Details

I. General information

NPI: 1962592212
Provider Name (Legal Business Name): ARLENE JOHANNA VANDERDUSSEN ARNP, MN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 FAIRVIEW AVE E SUITE E
SEATTLE WA
98102-3051
US

IV. Provider business mailing address

3123 FAIRVIEW AVE E SUITE E
SEATTLE WA
98102-3051
US

V. Phone/Fax

Practice location:
  • Phone: 206-324-4503
  • Fax: 206-328-1257
Mailing address:
  • Phone: 206-324-4503
  • Fax: 206-328-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberAP30005951
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP30005951
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: