Healthcare Provider Details

I. General information

NPI: 1710068598
Provider Name (Legal Business Name): SHARI SYRDAL JAQUES ARNP MN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17440 BROOKSIDE BLVD NE
LAKE FOREST PARK WA
98155
US

IV. Provider business mailing address

PO BOX 292 1306 LAKEVIEW DRIVE
SNOHOMISH WA
98291-0292
US

V. Phone/Fax

Practice location:
  • Phone: 206-366-9384
  • Fax: 206-364-0076
Mailing address:
  • Phone: 360-568-8737
  • Fax: 360-568-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30004096
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00044602
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: