Provider Demographics
NPI:1578744199
Name:KULGREN, REBECCA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:KULGREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4201
Mailing Address - Country:US
Mailing Address - Phone:206-860-4541
Mailing Address - Fax:206-860-4587
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:STE 1600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-860-4541
Practice Address - Fax:206-860-4587
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6027394-1205207V00000X
AZ40270207V00000X
WA60082291207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology