Basic Information
| Provider Information | |||||||||
| NPI: | 1699737395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PUENTE | ||||||||
| FirstName: | JEUDIEL | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26323 NE 25TH ST | ||||||||
| Address2: | |||||||||
| City: | REDMOND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980539081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252139915 | ||||||||
| FaxNumber: | 4258987105 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065984260 | ||||||||
| FaxNumber: | 2065988812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 01/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00156597 | WA | N | Nursing Service Providers | Registered Nurse | 367500000X | AP30006800 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 9642901 | 05 | WA | MEDICAID | 8939758 | 01 | WA | L & I CRIME VICTIMS | OTHER | 0191489 | 01 | WA | LABOR & INDUSTRY | OTHER | 62103U | 01 | WA | REGENCE BLUESHIELD | OTHER |