Provider Demographics
NPI:1174702526
Name:CHENG, IMELDA C (NP)
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:C
Last Name:CHENG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:3322 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4425
Practice Address - Country:US
Practice Address - Phone:425-249-4822
Practice Address - Fax:425-339-8283
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2011-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WARN00167426363LF0000X
WAAP30007978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30007978OtherNP LICENSE