Healthcare Provider Details

I. General information

NPI: 1760589311
Provider Name (Legal Business Name): DEBORAH JEAN WATJE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1925 NE 32ND ST
RENTON WA
98056-2178
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2183
  • Fax:
Mailing address:
  • Phone: 206-794-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30007314
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP30007314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: