Healthcare Provider Details

I. General information

NPI: 1851857775
Provider Name (Legal Business Name): SHEILAH MBURU MBATAI RND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHEILAH WAMBUI MBURU

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MADISON ST
EVERETT WA
98203-4543
US

IV. Provider business mailing address

7415 46TH AVE W
MUKILTEO WA
98275-2504
US

V. Phone/Fax

Practice location:
  • Phone: 425-212-4200
  • Fax:
Mailing address:
  • Phone: 206-913-3944
  • Fax: 425-374-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61398281
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00150894
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: