MEDICARE: JESSICA RAVITSKY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN00146672	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NONE

General Provider Information

NPI Number	:	1568942282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RAVITSKY RN

Provider Business Mailing Address
First Line	:	9335 47TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2607
Country	:	US
Telephone Number	:	206-719-4346
Fax Number	:

Provider Business Practice Location Address
First Line	:	9335 47TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2607
Country	:	US
Telephone Number	:	206-719-4346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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