Basic Information
Provider Information
NPI: 1497093140
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: YANSU
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125226
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber: 2063262785
Practice Location
Address1: 125 16TH AVE E
Address2:  
City: SEATTLE
State: WA
PostalCode: 981125211
CountryCode: US
TelephoneNumber: 2063263000
FaxNumber: 2063262785
Other Information
ProviderEnumerationDate: 01/30/2013
LastUpdateDate: 04/15/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/15/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X60286758WAN Nursing Service ProvidersRegistered Nurse 
363LF0000XAP60304658WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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