Provider Demographics
NPI:1245294602
Name:WALDEN, RENEE AMELIA (ARNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:AMELIA
Last Name:WALDEN
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 1:560 QUICK RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9324
Mailing Address - Country:US
Mailing Address - Phone:360-274-6150
Mailing Address - Fax:
Practice Address - Street 1:560 QUICK RD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611-9324
Practice Address - Country:US
Practice Address - Phone:360-274-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005004207X00000X, 363LF0000X
OR08201297N3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9644634Medicaid
WA6687WAOtherREGENCE BLUE SHIELD
WA830346687-98611-A001OtherTRICARE
WA8940830OtherCRIME VICTIMS OF WA
WA194936OtherLABOR & INDUSTRIES
OR210235Medicaid
WA6687WAOtherREGENCE BLUE SHIELD
WAS68697Medicare UPIN