Healthcare Provider Details

I. General information

NPI: 1093372070
Provider Name (Legal Business Name): NICOLE THERESA REES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

IV. Provider business mailing address

3815 S OTHELLO ST
SEATTLE WA
98118-3510
US

V. Phone/Fax

Practice location:
  • Phone: 206-788-3500
  • Fax: 206-788-3521
Mailing address:
  • Phone: 206-788-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2019-0048
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberPA19315
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61274889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: