Healthcare Provider Details

I. General information

NPI: 1598011371
Provider Name (Legal Business Name): MISOOK JOO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MISOOK LEE

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22618 HIGHWAY 99 STE 106
EDMONDS WA
98026-8395
US

IV. Provider business mailing address

22618 HIGHWAY 99 STE 106
EDMONDS WA
98026-8395
US

V. Phone/Fax

Practice location:
  • Phone: 425-409-9247
  • Fax: 206-535-2442
Mailing address:
  • Phone: 425-409-9247
  • Fax: 206-535-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60302041
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP60302041
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: