Healthcare Provider Details

I. General information

NPI: 1679610885
Provider Name (Legal Business Name): KI-DEUK WOHLFERT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUE WOHLFERT ARNP

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N DIVISION ST STE 301
AUBURN WA
98001-4939
US

IV. Provider business mailing address

202 N DIVISION ST STE 301
AUBURN WA
98001-4939
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7256
  • Fax:
Mailing address:
  • Phone: 253-833-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006909
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30006909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: