Healthcare Provider Details

I. General information

NPI: 1356013395
Provider Name (Legal Business Name): PEARL O. BAUTISTA RN, RNFA, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROADWAY FL 6
SEATTLE WA
98122-5330
US

IV. Provider business mailing address

601 BROADWAY FL 6
SEATTLE WA
98122-5330
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2600
  • Fax: 206-622-1644
Mailing address:
  • Phone: 206-386-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00128124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: