Healthcare Provider Details

I. General information

NPI: 1548525637
Provider Name (Legal Business Name): DANA ELIZABETH HESTMARK VAN BUECKEN MN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DANA ELIZABETH HESTMARK

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 11/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

6278 NE RADFORD DR APT. 3114
SEATTLE WA
98115-8712
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6600
  • Fax:
Mailing address:
  • Phone: 303-437-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60317796
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60173957
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: