Healthcare Provider Details

I. General information

NPI: 1104394097
Provider Name (Legal Business Name): REGINAH NAMPINGA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 112TH ST SW
EVERETT WA
98204-4875
US

IV. Provider business mailing address

1019 112TH ST SW
EVERETT WA
98204-4875
US

V. Phone/Fax

Practice location:
  • Phone: 425-551-6216
  • Fax:
Mailing address:
  • Phone: 425-551-6216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60326130
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number60979518
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: