Healthcare Provider Details

I. General information

NPI: 1780088278
Provider Name (Legal Business Name): MEN OK ZIYU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22502 NE 139TH ST
BRUSH PRAIRIE WA
98606-9409
US

IV. Provider business mailing address

22502 NE 139TH ST
BRUSH PRAIRIE WA
98606-9409
US

V. Phone/Fax

Practice location:
  • Phone: 360-784-0914
  • Fax: 360-828-8337
Mailing address:
  • Phone: 360-784-0914
  • Fax: 360-828-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60158003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: