Provider Demographics
NPI:1497389886
Name:LE, PHUONG (ARNP)
Entity type:Individual
Prefix:
First Name:PHUONG
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:4509 TALBOT RD S STE 105
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6294
Mailing Address - Country:US
Mailing Address - Phone:360-350-9230
Mailing Address - Fax:
Practice Address - Street 1:4509 TALBOT RD S STE 105
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6294
Practice Address - Country:US
Practice Address - Phone:360-350-9230
Practice Address - Fax:253-627-6576
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60289892163W00000X
WAAP61175056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2180716Medicaid