Healthcare Provider Details

I. General information

NPI: 1770198400
Provider Name (Legal Business Name): IRENE WAMBUI KAMAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31821 34TH PL SW
FEDERAL WAY WA
98023-2235
US

IV. Provider business mailing address

36244 23RD PL S
FEDERAL WAY WA
98003-8369
US

V. Phone/Fax

Practice location:
  • Phone: 678-707-3234
  • Fax:
Mailing address:
  • Phone: 678-707-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP61074133
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60866963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: