Healthcare Provider Details

I. General information

NPI: 1649134453
Provider Name (Legal Business Name): QUEENA CHAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 POINTES DR
MUKILTEO WA
98275-6038
US

IV. Provider business mailing address

4686 POINTES DR
MUKILTEO WA
98275-6038
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-8089
  • Fax:
Mailing address:
  • Phone: 425-405-8089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70073533
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: