Provider Demographics
NPI:1598011371
Name:JOO, MISOOK (NP)
Entity Type:Individual
Prefix:MRS
First Name:MISOOK
Middle Name:
Last Name:JOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MISOOK
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22618 HIGHWAY 99 STE 106
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8395
Mailing Address - Country:US
Mailing Address - Phone:425-409-9247
Mailing Address - Fax:206-535-2442
Practice Address - Street 1:22618 HIGHWAY 99 STE 106
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8395
Practice Address - Country:US
Practice Address - Phone:425-409-9247
Practice Address - Fax:206-535-2442
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60302041364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60302041Medicaid