Provider Demographics
NPI:1376625822
Name:LIENESCH, CHERYL ROSE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ROSE
Last Name:LIENESCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:ROSE
Other - Last Name:ZOMPETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-0430
Mailing Address - Country:US
Mailing Address - Phone:425-656-5525
Mailing Address - Fax:425-656-4228
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-656-5525
Practice Address - Fax:425-656-4228
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003025363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9612029Medicaid