Provider Demographics
NPI:1447674247
Name:SCHUERENBERG, NICOLE (CNA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:SCHUERENBERG
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 123RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8815
Mailing Address - Country:US
Mailing Address - Phone:425-344-7475
Mailing Address - Fax:
Practice Address - Street 1:16040 CHRISTENSEN RD STE 102
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2965
Practice Address - Country:US
Practice Address - Phone:206-457-4458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10069011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health