Healthcare Provider Details

I. General information

NPI: 1053603548
Provider Name (Legal Business Name): REBECCA ANNE BIRDSONG MN, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 EVANSTON AVE N SUITE 307
SEATTLE WA
98103-8626
US

IV. Provider business mailing address

3417 EVANSTON AVE N SUITE 307
SEATTLE WA
98103-8626
US

V. Phone/Fax

Practice location:
  • Phone: 206-351-5376
  • Fax: 844-324-0802
Mailing address:
  • Phone: 206-351-5376
  • Fax: 844-324-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60448894
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60105128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: