Healthcare Provider Details

I. General information

NPI: 1952616534
Provider Name (Legal Business Name): RENEE VALERIE MALDONADO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2010
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SW 136TH ST
BURIEN WA
98166-1214
US

IV. Provider business mailing address

912 S 73RD ST
TACOMA WA
98408-4308
US

V. Phone/Fax

Practice location:
  • Phone: 206-257-6601
  • Fax:
Mailing address:
  • Phone: 253-886-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number33063
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00047980
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: