Basic Information
| Provider Information | |||||||||
| NPI: | 1083765515 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PESENSON | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068604478 | ||||||||
| FaxNumber: | 2063255150 | ||||||||
| Practice Location | |||||||||
| Address1: | 904 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981041132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068604478 | ||||||||
| FaxNumber: | 2063255150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 10/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD 00046540 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 25MA08298200 | NJ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | P00847698 | 01 | WA | RAILROAD | OTHER | 0255550 | 01 | WA | STATE L&I | OTHER | 0273315 | 01 | WA | STATE L&I | OTHER |