Provider Demographics
NPI:1396942728
Name:RAMICK, BETTINA DARA (LMP)
Entity type:Individual
Prefix:MS
First Name:BETTINA
Middle Name:DARA
Last Name:RAMICK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DEREKS PL
Mailing Address - Street 2:
Mailing Address - City:PACIFIC
Mailing Address - State:WA
Mailing Address - Zip Code:98047-1450
Mailing Address - Country:US
Mailing Address - Phone:206-734-1879
Mailing Address - Fax:253-852-2830
Practice Address - Street 1:25658 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-7610
Practice Address - Country:US
Practice Address - Phone:253-852-2830
Practice Address - Fax:253-852-2828
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0015385170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00015385OtherLICENSE