Healthcare Provider Details

I. General information

NPI: 1427953520
Provider Name (Legal Business Name): AMBREEN SOOMRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 S CUSHMAN AVE
TACOMA WA
98405-3631
US

IV. Provider business mailing address

9710 STATE AVE
MARYSVILLE WA
98270-2232
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-2144
  • 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 StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: