1083195689 NPI number — RUTH WANJIRU NJENGA MA60589837

Table of content: RUTH WANJIRU NJENGA MA60589837 (NPI 1083195689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083195689 NPI number — RUTH WANJIRU NJENGA MA60589837

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NJENGA
Provider First Name:
RUTH
Provider Middle Name:
WANJIRU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA60589837
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NJENGA
Provider Other First Name:
RUTH
Provider Other Middle Name:
WANJIRU
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA60589837
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1083195689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19641 SE 259TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98042-5045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-397-8602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19641 SE 259TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98042-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-397-8602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA60589837 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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