MEDICARE: MISS PRISCA NWIZUGBO ARNP, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	AP60196567	WA

General Provider Information

NPI Number	:	1184922874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PRISCA NWIZUGBO ARNP, PMHNP

Provider Business Mailing Address
First Line	:	15 S GRADY WAY STE 249
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3209
Country	:	US
Telephone Number	:	425-233-0431
Fax Number	:	425-329-8087

Provider Business Practice Location Address
First Line	:	15 S GRADY WAY STE 249
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3209
Country	:	US
Telephone Number	:	425-233-0431
Fax Number	:	425-329-8087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	05/01/2025

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