Healthcare Provider Details

I. General information

NPI: 1588224711
Provider Name (Legal Business Name): MERCY MUGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 NE 33RD PL STE 202
BELLEVUE WA
98004-1444
US

IV. Provider business mailing address

11120 NE 33RD PL STE 202
BELLEVUE WA
98004-1444
US

V. Phone/Fax

Practice location:
  • Phone: 206-823-1004
  • Fax: 206-309-3319
Mailing address:
  • Phone: 206-823-1004
  • Fax: 206-309-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60965876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: