Provider Demographics
NPI:1205302478
Name:THEIS, CHRISTINA SUJIN (ARNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SUJIN
Last Name:THEIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:SUJIN
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-332-6948
Mailing Address - Fax:425-304-1102
Practice Address - Street 1:3916 148TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012
Practice Address - Country:US
Practice Address - Phone:425-332-6948
Practice Address - Fax:425-304-1102
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60903574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily