Healthcare Provider Details

I. General information

NPI: 1598758328
Provider Name (Legal Business Name): KAREN RONGREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 NE BOTHELL WAY STE G
KENMORE WA
98028-9403
US

IV. Provider business mailing address

403 E MEEKER ST
KENT WA
98030-5904
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2866
  • Fax: 253-852-3102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30004780
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: