Healthcare Provider Details

I. General information

NPI: 1184098576
Provider Name (Legal Business Name): AGNES NDIRITU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1728 W MARINE VIEW DR STE 106
EVERETT WA
98201-2094
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5453
  • Fax: 425-252-4441
Mailing address:
  • Phone: 425-339-5453
  • Fax: 425-252-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60886598
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2283375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: