Healthcare Provider Details

I. General information

NPI: 1801701388
Provider Name (Legal Business Name): GLORY MALENGA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 3RD AVE SE APT 124
EVERETT WA
98208-3976
US

IV. Provider business mailing address

10220 3RD AVE SE APT 124
EVERETT WA
98208-3976
US

V. Phone/Fax

Practice location:
  • Phone: 425-534-8214
  • Fax:
Mailing address:
  • Phone:
  • Fax: 425-534-8214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.LP.70111930
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: