Healthcare Provider Details

I. General information

NPI: 1104676535
Provider Name (Legal Business Name): JIA HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 NW FAIRWAY LN
BREMERTON WA
98312-1341
US

IV. Provider business mailing address

3924 NW FAIRWAY LN
BREMERTON WA
98312-1341
US

V. Phone/Fax

Practice location:
  • Phone: 360-900-9737
  • Fax:
Mailing address:
  • Phone: 360-900-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60765546
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61539090
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: