Healthcare Provider Details

I. General information

NPI: 1881062990
Provider Name (Legal Business Name): L'OREAL KENNEDY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 470
RENTON WA
98055-5700
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5062
  • Fax: 425-656-4032
Mailing address:
  • Phone: 425-228-3440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60652959
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: