Healthcare Provider Details

I. General information

NPI: 1346274677
Provider Name (Legal Business Name): THERESE DEMPSEY VAFAEEZADEH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S M2-8
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

12604 NE 112TH PL
KIRKLAND WA
98033-4110
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-1042
  • Fax:
Mailing address:
  • Phone: 425-822-7039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006824
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: