Provider Demographics
NPI:1225558570
Name:SCEGO, RODA M (DNP ARNP CNM)
Entity Type:Individual
Prefix:
First Name:RODA
Middle Name:M
Last Name:SCEGO
Suffix:
Gender:F
Credentials:DNP ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16045 1ST AVE S FL 2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1401
Mailing Address - Country:US
Mailing Address - Phone:206-965-4200
Mailing Address - Fax:253-627-7880
Practice Address - Street 1:16045 1ST AVE S FL 2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4200
Practice Address - Fax:253-627-7880
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60765619367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2088528Medicaid