Healthcare Provider Details

I. General information

NPI: 1770398380
Provider Name (Legal Business Name): NKECHI KATE RUNYAN CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30230 21ST AVE S
FEDERAL WAY WA
98003-4249
US

IV. Provider business mailing address

30230 21ST AVE S
FEDERAL WAY WA
98003-4249
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 206-399-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberST61656235
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberST61656235
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: