Provider Demographics
NPI:1326010968
Name:LETRAN, JACQUELINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:LETRAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:HONGNGOC
Other - Middle Name:THI
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10700 SE 260TH ST
Mailing Address - Street 2:J102
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-7699
Mailing Address - Country:US
Mailing Address - Phone:206-326-9448
Mailing Address - Fax:
Practice Address - Street 1:204 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5015
Practice Address - Country:US
Practice Address - Phone:253-735-8336
Practice Address - Fax:253-735-8833
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS22948Medicare UPIN