Provider Demographics
NPI:1699737395
Name:PUENTE, JEUDIEL R (CRNA)
Entity type:Individual
Prefix:
First Name:JEUDIEL
Middle Name:R
Last Name:PUENTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26323 NE 25TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-9081
Mailing Address - Country:US
Mailing Address - Phone:425-213-9915
Mailing Address - Fax:425-898-7105
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4260
Practice Address - Fax:206-598-8812
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00156597163W00000X
WAAP30006800367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642901Medicaid
WA8939758OtherL & I CRIME VICTIMS
WA0191489OtherLABOR & INDUSTRY
WA62103UOtherREGENCE BLUESHIELD
WA8939758OtherL & I CRIME VICTIMS
WA8850903Medicare ID - Type UnspecifiedMEDICARE