Healthcare Provider Details

I. General information

NPI: 1619896271
Provider Name (Legal Business Name): MAUREEN MIRINGU
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

30801 28TH AVE S
FEDERAL WAY WA
98003-5104
US

V. Phone/Fax

Practice location:
  • Phone: 206-468-7901
  • Fax:
Mailing address:
  • Phone: 206-304-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP61549136
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: