Healthcare Provider Details

I. General information

NPI: 1104315167
Provider Name (Legal Business Name): QUYEN TRAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RUCKER AVE
EVERETT WA
98203-2237
US

IV. Provider business mailing address

4201 RUCKER AVE
EVERETT WA
98203-2237
US

V. Phone/Fax

Practice location:
  • Phone: 425-382-4000
  • Fax:
Mailing address:
  • Phone: 425-382-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60766315
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60909982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: