Healthcare Provider Details

I. General information

NPI: 1881241461
Provider Name (Legal Business Name): LISA THU NGUYEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 3RD ST SE STE 300
PUYALLUP WA
98372-3771
US

IV. Provider business mailing address

16515 MERIDIAN E STE 104A
PUYALLUP WA
98375-6255
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-1420
  • Fax:
Mailing address:
  • Phone: 253-792-6650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60991328
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: