Healthcare Provider Details

I. General information

NPI: 1417627084
Provider Name (Legal Business Name): COCO SHUANG LI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 3RD AVE NE STE 208
SEATTLE WA
98115-2023
US

IV. Provider business mailing address

19507 82ND PL W
EDMONDS WA
98026-6209
US

V. Phone/Fax

Practice location:
  • Phone: 206-698-7493
  • Fax:
Mailing address:
  • Phone: 206-698-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61492871
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00167479
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: