Individual provider Active NPI

Su Yeon Yu, ARNP

  • Nurse Practitioner
  • Lacey, WA
National Provider Identifier
1609445295
Registry record updated Feb 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP61159886 Issued in WA
Practice address
4800 College St SE
Lacey, WA 98503-4389
Phone
(360) 413-4250
NPI assigned
Jun 18, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AP61159886 WA Primary

Addresses

Primary practice location

4800 College St SE
Lacey, WA 98503-4389

Mailing address

PO Box 3360
Portland, OR 97208-3360

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210701003530 WA Practitioner - Nurse Practitioner 8729489331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4800 College St SE
Lacey, WA 98503-4389
Phone (360) 486-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61159886WAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Washington CurrentSince Jun 18, 2022 Accepting new patients

Locations

4800 College St SE
Olympia, WA 98503
Phone (360) 456-7575

525 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8550

Interoperability endpoints

  • Direct secure messaging: syu2066469@wm.providencedirect.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1609445295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3360",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 COLLEGE ST SE",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985034389",
            "telephone_number": "360-413-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YU",
        "first_name": "SU YEON",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-18",
        "last_updated": "2023-02-15",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP61159886",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

Verify at the official NPI Registry.