Healthcare Provider Details

I. General information

NPI: 1154928901
Provider Name (Legal Business Name): MERCY OMIJIE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

18412 W MISSION LN
WADDELL AZ
85355-4303
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax: 425-212-4201
Mailing address:
  • Phone: 206-683-5201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number256824
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61190062
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN178436
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: