Provider Demographics
NPI:1700818309
Name:RUDDELL, JAIME D (ARNP)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:D
Last Name:RUDDELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:D
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 24366
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0366
Mailing Address - Country:US
Mailing Address - Phone:206-598-0502
Mailing Address - Fax:206-598-0516
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-2675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00129892163W00000X
WAAP300006728363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0208340OtherLABOR & INDUSTRIES
WA9641564Medicaid
WA09779UOtherREGENCE BLUESHIELD
WA0208340OtherLABOR & INDUSTRIES
WA9641564Medicaid
WAG8877621Medicare PIN