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General NPI Number Information
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NPI Number | 1932037868
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Entity Type | Individual
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Provider Name | WENDY RENEE PETERSEN SUDPT
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Gender | Female
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Dates
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Enumeration Date | 05/11/2026
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Last Update Date | 05/11/2026
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Provider Practice Location Address
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Address Line | 701 N 36TH ST STE 300
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City | SEATTLE
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State | WA
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Zip | 98103-8868
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Country | US
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Telephone | 206-216-5000
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Fax | 206-216-5002
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Provider Business Mailing Address
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Address Line | 1808 1ST AVE W
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City | SEATTLE
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State | WA
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Zip | 98119-3006
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Country | US
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Telephone | 206-972-7895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | CO70064878
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License Number State | WA
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