Provider Demographics
NPI:1528842499
Name:OAKLEY, SOREN ELLIOTT (BSN, RN)
Entity type:Individual
Prefix:MR
First Name:SOREN
Middle Name:ELLIOTT
Last Name:OAKLEY
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MAE LYNN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6228 S 238TH ST APT M205
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3878
Mailing Address - Country:US
Mailing Address - Phone:253-569-4394
Mailing Address - Fax:
Practice Address - Street 1:33811 9TH AVE S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6707
Practice Address - Country:US
Practice Address - Phone:253-533-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61207601163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics