Healthcare Provider Details

I. General information

NPI: 1104441070
Provider Name (Legal Business Name): HAAYOUNG LEE HWANGPO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST
SEATTLE WA
98195-7263
US

IV. Provider business mailing address

1959 NE PACIFIC ST
SEATTLE WA
98195-7263
US

V. Phone/Fax

Practice location:
  • Phone: 206-543-8736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60410490
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61088369
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: