Healthcare Provider Details

I. General information

NPI: 1538088133
Provider Name (Legal Business Name): NIKI YEBOAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35810 16TH AVE S APT D301
FEDERAL WAY WA
98003-7472
US

IV. Provider business mailing address

15365 200TH AVE E
BONNEY LAKE WA
98391-8043
US

V. Phone/Fax

Practice location:
  • Phone: 206-468-7901
  • Fax:
Mailing address:
  • Phone: 470-263-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.LP.61544532
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: