Healthcare Provider Details

I. General information

NPI: 1821604737
Provider Name (Legal Business Name): CLAUDE DAVID WEEDON RN, MN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 THOMPSON DRIVE
SEDRO WOOLLEY WA
98284
US

IV. Provider business mailing address

7440 W MARGINAL WAY S
SEATTLE WA
98108-4141
US

V. Phone/Fax

Practice location:
  • Phone: 360-856-3186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00088133
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: