Provider Demographics
NPI:1609836717
Name:NAM, GLORIA YOUNGJU (ARNP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:YOUNGJU
Last Name:NAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:YOUNG
Other - Middle Name:J
Other - Last Name:NAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33507 9TH AVE. S.
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6397
Mailing Address - Country:US
Mailing Address - Phone:253-874-5404
Mailing Address - Fax:253-874-8964
Practice Address - Street 1:33507 9TH AVE. S.
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6397
Practice Address - Country:US
Practice Address - Phone:253-874-5404
Practice Address - Fax:253-874-8964
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00153013163W00000X
WAAP30006808207Q00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643594Medicaid
Q65148Medicare UPIN
WA8858885Medicare PIN
WAQ65148Medicare UPIN