Healthcare Provider Details

I. General information

NPI: 1295371771
Provider Name (Legal Business Name): NGHI QUE NGO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 10/30/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 GRAHAM AVE STE 100
SUMNER WA
98390-2728
US

IV. Provider business mailing address

5814 GRAHAM AVE STE 100
SUMNER WA
98390-2728
US

V. Phone/Fax

Practice location:
  • Phone: 253-891-7450
  • Fax:
Mailing address:
  • Phone: 253-891-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61341988
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: