Healthcare Provider Details

I. General information

NPI: 1679463871
Provider Name (Legal Business Name): ANNIKA CHAN THACH FNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 10TH ST NE
AUBURN WA
98002-4045
US

IV. Provider business mailing address

205 10TH ST NE
AUBURN WA
98002-4045
US

V. Phone/Fax

Practice location:
  • Phone: 253-351-5300
  • Fax: 253-351-5399
Mailing address:
  • Phone: 253-351-5300
  • Fax: 253-351-5399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70020287
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: