Healthcare Provider Details

I. General information

NPI: 1376010355
Provider Name (Legal Business Name): JENNAE HUANG CARPIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MARTIN LUTHER KING JR WAY S
SEATTLE WA
98144-6847
US

IV. Provider business mailing address

4302 RIVERFRONT BLVD
EVERETT WA
98203-7011
US

V. Phone/Fax

Practice location:
  • Phone: 206-695-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: