Healthcare Provider Details

I. General information

NPI: 1013944339
Provider Name (Legal Business Name): RITA KATHRYN WISE ARNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 GREYWOLF RD
SEQUIM WA
98382-7573
US

IV. Provider business mailing address

417 GREYWOLF RD
SEQUIM WA
98382-7573
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-9233
  • Fax: 360-582-9233
Mailing address:
  • Phone: 360-582-9233
  • Fax: 360-582-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP30006988
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60005736
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006988
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00158838
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: