Healthcare Provider Details

I. General information

NPI: 1821521022
Provider Name (Legal Business Name): ALLAN TAKPUIE R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22026 20TH AVE SE SUITE 101
BOTHELL WA
98021-4449
US

IV. Provider business mailing address

22026 20TH AVE SE SUITE 101
BOTHELL WA
98021-4449
US

V. Phone/Fax

Practice location:
  • Phone: 425-672-7293
  • Fax: 425-329-4640
Mailing address:
  • Phone: 425-672-7293
  • Fax: 425-329-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN60476455
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: