Healthcare Provider Details

I. General information

NPI: 1922729524
Provider Name (Legal Business Name): PORTIA SHARMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 NE PACIFIC ST
SEATTLE WA
98195-0009
US

IV. Provider business mailing address

13804 41ST AVE W
LYNNWOOD WA
98087-1225
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-8736
  • Fax:
Mailing address:
  • Phone: 206-401-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61688761
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60383915
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: