Healthcare Provider Details

I. General information

NPI: 1720642333
Provider Name (Legal Business Name): IFEYINWA AMUCHE NWANGWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19803 N CREEK PKWY STE 205
BOTHELL WA
98011-5014
US

IV. Provider business mailing address

19803 N CREEK PKWY STE 205
BOTHELL WA
98011-5014
US

V. Phone/Fax

Practice location:
  • Phone: 206-291-2981
  • Fax: 425-427-2477
Mailing address:
  • Phone: 206-291-2981
  • Fax: 425-427-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number61446852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: