Provider Demographics
NPI:1679648208
Name:WAPSTRA, ROSA LEE (RN, MS)
Entity Type:Individual
Prefix:
First Name:ROSA LEE
Middle Name:
Last Name:WAPSTRA
Suffix:
Gender:F
Credentials:RN, MS
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAMARITAN COUNSELING CENTER OF NORTH PUGET SOUND
Mailing Address - Street 2:13TH AND LAKEVIEW AVE
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98291-0292
Mailing Address - Country:US
Mailing Address - Phone:360-568-8737
Mailing Address - Fax:360-568-1654
Practice Address - Street 1:SAMARITAN COUNSELING CENTER OF NORTH PUGET SOUND
Practice Address - Street 2:13TH AND LAKEVIEW AVE
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98291-0292
Practice Address - Country:US
Practice Address - Phone:360-568-8737
Practice Address - Fax:360-568-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WALF00001417106H00000X
WARN00034191163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4461OtherREGENCE PROVIDER #
5841032OtherAETNA PRODIVER ID