Healthcare Provider Details

I. General information

NPI: 1023694908
Provider Name (Legal Business Name): BEHAUDEN OMER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BEHAUDEN OMER BEHAUDEN OMER, RN

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 AIRPORT WAY S STE 227
SEATTLE WA
98134-2167
US

IV. Provider business mailing address

3250 AIRPORT WAY S STE 227
SEATTLE WA
98134-2167
US

V. Phone/Fax

Practice location:
  • Phone: 425-477-9208
  • Fax:
Mailing address:
  • Phone: 425-477-9208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61237807
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00172133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: