Healthcare Provider Details

I. General information

NPI: 1053990036
Provider Name (Legal Business Name): EMMA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-0001
US

IV. Provider business mailing address

1705 NE PACIFIC ST SEATTLE WA 98195
SEATTLE WA
98195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-3689
  • Fax:
Mailing address:
  • Phone: 206-616-3689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.MD.70063276
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: