Healthcare Provider Details

I. General information

NPI: 1407855521
Provider Name (Legal Business Name): JUDITH E DAVIDSON RN, ARNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 N 5TH AVE
SEQUIM WA
98382-3080
US

IV. Provider business mailing address

PO BOX 389674 MSC 18913
TUKWILA WA
98138-9674
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-2010
  • Fax: 360-683-2320
Mailing address:
  • Phone: 360-658-2700
  • Fax: 360-658-5091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00075669
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP30006215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: