Provider Demographics
NPI:1386717809
Name:ROTECKI, NANCY S (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:ROTECKI
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1238
Mailing Address - Country:US
Mailing Address - Phone:206-723-7365
Mailing Address - Fax:206-723-7365
Practice Address - Street 1:10821 8TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-2225
Practice Address - Country:US
Practice Address - Phone:206-205-7210
Practice Address - Fax:206-296-4595
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001295176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS71541Medicare UPIN
WAAB07391Medicare ID - Type Unspecified