Healthcare Provider Details

I. General information

NPI: 1932037868
Provider Name (Legal Business Name): WENDY RENEE PETERSEN SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 N 36TH ST STE 300
SEATTLE WA
98103-8868
US

IV. Provider business mailing address

1808 1ST AVE W
SEATTLE WA
98119-3006
US

V. Phone/Fax

Practice location:
  • Phone: 206-216-5000
  • Fax: 206-216-5002
Mailing address:
  • Phone: 206-972-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCO70064878
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: