Healthcare Provider Details

I. General information

NPI: 1861576761
Provider Name (Legal Business Name): NABATANZI AGNES BEWAYO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 333RD ST STE 105
FEDERAL WAY WA
98003-7099
US

IV. Provider business mailing address

PO BOX 58608
RENTON WA
98058-1608
US

V. Phone/Fax

Practice location:
  • Phone: 971-251-5788
  • Fax:
Mailing address:
  • Phone: 404-558-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number047964
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60752475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: