Healthcare Provider Details

I. General information

NPI: 1326079336
Provider Name (Legal Business Name): SALLY A. RAGSDALE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE BOX 359860
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE BOX 359860
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-4191
  • Fax: 206-744-8527
Mailing address:
  • Phone: 206-744-4191
  • Fax: 206-744-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006539
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30006539
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30006539
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006539
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: