Healthcare Provider Details

I. General information

NPI: 1861944993
Provider Name (Legal Business Name): MR. EMMANUEL NDUBUISI NWABUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NONE NONE NONE NP

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 112TH AVE NE STE 201
BELLEVUE WA
98004-2945
US

IV. Provider business mailing address

2105 112TH AVE NE STE 201
BELLEVUE WA
98004-2945
US

V. Phone/Fax

Practice location:
  • Phone: 844-336-6463
  • Fax:
Mailing address:
  • Phone: 844-336-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61055877
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: