Healthcare Provider Details

I. General information

NPI: 1902730864
Provider Name (Legal Business Name): DAISY MENISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21200 SE 416TH ST
ENUMCLAW WA
98022-9012
US

IV. Provider business mailing address

1343 MARION ST
ENUMCLAW WA
98022-2624
US

V. Phone/Fax

Practice location:
  • Phone: 206-390-7601
  • Fax:
Mailing address:
  • Phone: 206-390-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00155800
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: