Healthcare Provider Details

I. General information

NPI: 1699454595
Provider Name (Legal Business Name): JESSICA TRUONG AP61463253
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16549 AURORA AVE N
SHORELINE WA
98133-5308
US

IV. Provider business mailing address

225 27TH AVE E
SEATTLE WA
98112-5426
US

V. Phone/Fax

Practice location:
  • Phone: 206-533-2600
  • Fax:
Mailing address:
  • Phone: 206-335-2306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP6143253
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: