Healthcare Provider Details

I. General information

NPI: 1497287130
Provider Name (Legal Business Name): SUNDAY THURSTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19221 90TH PL NE
BOTHELL WA
98011-2253
US

IV. Provider business mailing address

19221 90TH PL NE
BOTHELL WA
98011-2253
US

V. Phone/Fax

Practice location:
  • Phone: 206-650-3077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00049245
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: