Healthcare Provider Details

I. General information

NPI: 1467800433
Provider Name (Legal Business Name): CINDY LOU CHOATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E PIONEER
PUYALLUP WA
98372-3265
US

IV. Provider business mailing address

325 E PIONEER
PUYALLUP WA
98372-3265
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8400
  • Fax: 253-697-3730
Mailing address:
  • Phone: 253-697-8400
  • Fax: 253-697-3730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN60123426
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: