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Individual

CHARISAO SRISUTHIPORNSAKUL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
7201 W GRANDRIDGE BLVD, KENNEWICK, WA 99336-6709
(509) 221-6900
Mailing address
570 CAMY ST, RICHLAND, WA 99352-7868
(608) 772-6123

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209008323
IL
363LF0000X
Family Nurse Practitioner
5098-33
WI
363LF0000X
Family Nurse Practitioner
Primary
AP60435520
WA

Other

Enumeration date
01/26/2011
Last updated
08/31/2020
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