=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871760280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA PRINCE PETERSEN M.D., M.SC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2008
-----------------------------------------------------
Last Update Date | 05/01/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1959 NE PACIFIC ST BOX 356410
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98195-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-321-8575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 50095 UNIVERSITY OF WASHINGTON PHYSICIANS
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98145-5095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-475-6827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 60071530
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------