Provider Demographics
NPI:1770749228
Name:HEDSTROM, ANNA BRUETT (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BRUETT
Last Name:HEDSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:LYNN
Other - Last Name:BRUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9222 STONE AVE N UNIT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-3326
Mailing Address - Country:US
Mailing Address - Phone:206-909-4450
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356320
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6320
Practice Address - Country:US
Practice Address - Phone:206-909-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602203842080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine