Healthcare Provider Details

I. General information

NPI: 1720171937
Provider Name (Legal Business Name): REBECCA KRUSE-JARRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 TERRY AVENUE
SEATTLE WA
98104
US

IV. Provider business mailing address

921 TERRY AVENUE
SEATTLE WA
98104
US

V. Phone/Fax

Practice location:
  • Phone: 206-292-6500
  • Fax: 206-689-8365
Mailing address:
  • Phone: 206-689-6507
  • Fax: 206-689-8341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number024803
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number60461062
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: