Provider Demographics
NPI:1306133665
Name:CHENG, AMY LOUISE (ARNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:CHENG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 SW GRADY WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5217
Mailing Address - Country:US
Mailing Address - Phone:425-254-3413
Mailing Address - Fax:
Practice Address - Street 1:1107 SW GRADY WAY STE 100
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5217
Practice Address - Country:US
Practice Address - Phone:425-254-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60228491363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health