Healthcare Provider Details

I. General information

NPI: 1194243915
Provider Name (Legal Business Name): JOY YEA FREY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY YEA CHANG ARNP

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3021 GRIFFIN AVE
ENUMCLAW WA
98022-2369
US

IV. Provider business mailing address

3021 GRIFFIN AVE STE 200
ENUMCLAW WA
98022-2369
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-6511
  • Fax: 360-825-6536
Mailing address:
  • Phone: 360-825-6511
  • Fax: 206-592-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60297609
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60796626
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: