MEDICARE: AMY LAUREN BRYCE ARNP

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	RN60459722	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60459723	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN60459722	OTHER	WA	RN LICENSE NUMBER
2	AP60459723	OTHER	WA	ARNP LICENSE NUMBER

General Provider Information

NPI Number	:	1720389075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LAUREN BRYCE ARNP

Provider Business Mailing Address
First Line	:	12460 3RD AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-2949
Country	:	US
Telephone Number	:	541-962-5027
Fax Number	:

Provider Business Practice Location Address
First Line	:	12460 3RD AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-2949
Country	:	US
Telephone Number	:	541-962-5027
Fax Number	:

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

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	03/23/2017

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