Provider Demographics
NPI:1295359206
Name:RYDELSKI, JESSICA MAE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MAE
Last Name:RYDELSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5577
Mailing Address - Country:US
Mailing Address - Phone:425-690-3475
Mailing Address - Fax:425-690-9475
Practice Address - Street 1:1205 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5577
Practice Address - Country:US
Practice Address - Phone:425-690-3475
Practice Address - Fax:425-690-9475
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61048379363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily