Individual
SIRITHEPPHAVANH OLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP-AC, ARNP
Contact information
Practice address
825 EASTLAKE AVE E, SEATTLE, WA 98109-4405
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 520-5700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60518948
WA
363LA2100X
Acute Care Nurse Practitioner
Primary
AP60518948
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013299197
—
WA
Enumeration date
09/14/2011
Last updated
05/02/2023
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