Basic Information
| Provider Information | |||||||||
| NPI: | 1104936020 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STICKLER | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34876 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256565412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4033 TALBOT RD S STE 530 | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980555700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252286076 | ||||||||
| FaxNumber: | 4252265224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G79112 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD 18482 | HI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD 60404605 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G791120 | 05 | CA | MEDICAID | 2032479 | 05 | WA | MEDICAID |