Provider Demographics
NPI:1720389075
Name:BRYCE, AMY LAUREN (ARNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LAUREN
Last Name:BRYCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12460 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-2949
Mailing Address - Country:US
Mailing Address - Phone:541-962-5027
Mailing Address - Fax:
Practice Address - Street 1:12460 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2949
Practice Address - Country:US
Practice Address - Phone:541-962-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60459722163W00000X
WAAP60459723363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN60459722OtherRN LICENSE NUMBER
WAAP60459723OtherARNP LICENSE NUMBER