Healthcare Provider Details

I. General information

NPI: 1598087942
Provider Name (Legal Business Name): BETHANY R. ROGERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 BOREN AVE SUITE 800
SEATTLE WA
98104-3595
US

IV. Provider business mailing address

600 BROADWAY SUITE 460
SEATTLE WA
98122-5395
US

V. Phone/Fax

Practice location:
  • Phone: 206-323-1900
  • Fax: 206-323-6868
Mailing address:
  • Phone: 206-323-1900
  • Fax: 206-709-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60121085
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: