Healthcare Provider Details

I. General information

NPI: 1205471059
Provider Name (Legal Business Name): BIANCA REIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ELLIOTT AVE W STE 500
SEATTLE WA
98119-4292
US

IV. Provider business mailing address

2212 QUEEN ANNE AVE N # 742
SEATTLE WA
98109-2383
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61074587
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number60015020
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: