Healthcare Provider Details

I. General information

NPI: 1386740058
Provider Name (Legal Business Name): QING CAO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20200 54TH AVE W
LYNNWOOD WA
98036-6318
US

IV. Provider business mailing address

20200 54TH AVE W
LYNNWOOD WA
98036-6318
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-6400
  • Fax: 425-672-6518
Mailing address:
  • Phone: 425-672-6400
  • Fax: 425-672-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200600393621
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: