Healthcare Provider Details

I. General information

NPI: 1659359677
Provider Name (Legal Business Name): DEBRA ANN PHELPS CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 WESTLAKE AVE N SUITE 100
SEATTLE WA
98109-5232
US

IV. Provider business mailing address

18717 22ND DR SE
BOTHELL WA
98012-8729
US

V. Phone/Fax

Practice location:
  • Phone: 206-448-5542
  • Fax:
Mailing address:
  • Phone: 425-503-5909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30003862
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: