Healthcare Provider Details

I. General information

NPI: 1841481751
Provider Name (Legal Business Name): ANNEMIEKE JEANETTE HIEMSTRA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNEMIEKE JEANETTE STEWART

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 11/27/2022
Certification Date: 11/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

9376 SE 46TH ST
MERCER ISLAND WA
98040-4405
US

V. Phone/Fax

Practice location:
  • Phone: 206-731-8386
  • Fax:
Mailing address:
  • Phone: 206-275-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30007718
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: