Healthcare Provider Details

I. General information

NPI: 1194547448
Provider Name (Legal Business Name): RUTH MONGARE DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LAKE BELLEVUE DR
BELLEVUE WA
98005-2417
US

IV. Provider business mailing address

1 LAKE BELLEVUE DR
BELLEVUE WA
98005-2417
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-4153
  • Fax: 425-800-6705
Mailing address:
  • Phone: 425-243-4153
  • Fax: 425-800-6705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61597683
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: