Provider Demographics
NPI:1326477712
Name:ROSDAHL, MARIAH (MSN)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:ROSDAHL
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34165
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1165
Mailing Address - Country:US
Mailing Address - Phone:206-252-0750
Mailing Address - Fax:
Practice Address - Street 1:2445 3RD AVE S
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1923
Practice Address - Country:US
Practice Address - Phone:206-252-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60287778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse