=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831285527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN CHRISTINE UPPENBERG-LIEDTKE ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PUGET SOUND HEALTH CARE SYSTEMS, AMERICAN LAKE 9600 VETERANS DRIVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-582-8440
-----------------------------------------------------
Fax | 253-583-4045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6517 80TH ST. S.W.
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-582-4108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | AP30003892
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------