Provider Demographics
NPI:1891477725
Name:WOLTERBEEK, RYAN MATTHEW
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:WOLTERBEEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 ALASKAN WAY S
Mailing Address - Street 2:MEDICAL
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1102
Mailing Address - Country:US
Mailing Address - Phone:206-217-6432
Mailing Address - Fax:
Practice Address - Street 1:2020 GUARDFISH ST
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98315-2001
Practice Address - Country:US
Practice Address - Phone:360-315-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman