Healthcare Provider Details

I. General information

NPI: 1720774193
Provider Name (Legal Business Name): JENNA CHEONG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 500
RENTON WA
98055-5782
US

IV. Provider business mailing address

4011 TALBOT RD S STE 500
RENTON WA
98055-5782
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3488
  • Fax: 425-690-9088
Mailing address:
  • Phone: 425-690-3488
  • Fax: 425-690-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61410460
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP61410460
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: