MEDICARE: GABRIEL SHUNTOKU UESONODA LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP70057418	WA

General Provider Information

NPI Number	:	1790627644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL SHUNTOKU UESONODA LPN

Provider Business Mailing Address
First Line	:	8444 N 90TH ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4437
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:	602-854-0504

Provider Business Practice Location Address
First Line	:	5130 EVERGREEN WAY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2875
Country	:	US
Telephone Number	:	425-683-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “ GABRIEL SHUNTOKU UESONODA LPN” Practice Location

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