Provider Demographics
NPI:1346688678
Name:PEDERSEN, DEAN (ARNP)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 S 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATAC
Mailing Address - State:WA
Mailing Address - Zip Code:98198-5202
Mailing Address - Country:US
Mailing Address - Phone:206-870-5700
Mailing Address - Fax:206-870-5735
Practice Address - Street 1:2425 S 200TH ST
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98198-5202
Practice Address - Country:US
Practice Address - Phone:206-870-5700
Practice Address - Fax:206-870-5735
Is Sole Proprietor?:No
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily