Provider Demographics
NPI:1063863330
Name:CHENG, NICOLE M (DNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CHENG
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 RUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4833
Mailing Address - Country:US
Mailing Address - Phone:425-339-5421
Mailing Address - Fax:425-317-3975
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5421
Practice Address - Fax:425-317-3975
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2025-01-22
Deactivation Date:2023-07-28
Deactivation Code:
Reactivation Date:2023-08-25
Provider Licenses
StateLicense IDTaxonomies
WAAP61550250363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health