Provider Demographics
NPI:1619228301
Name:SU, KRISTEN ELISE SHI (RN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELISE SHI
Last Name:SU
Suffix:
Gender:F
Credentials:RN, ANP-BC
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:ELISE
Other - Last Name:SHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ANP-BC
Mailing Address - Street 1:135 S 336TH ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6350
Mailing Address - Country:US
Mailing Address - Phone:253-835-7453
Mailing Address - Fax:
Practice Address - Street 1:135 S 336TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6350
Practice Address - Country:US
Practice Address - Phone:253-835-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60311591363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner