Healthcare Provider Details

I. General information

NPI: 1518441443
Provider Name (Legal Business Name): ANDI CHENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 3RD ST SE STE 106
PUYALLUP WA
98372-3730
US

IV. Provider business mailing address

1420 3RD ST SE STE 106
PUYALLUP WA
98372-3730
US

V. Phone/Fax

Practice location:
  • Phone: 253-268-0720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNU60884895
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: