Healthcare Provider Details

I. General information

NPI: 1669857074
Provider Name (Legal Business Name): PAUL NJOROGE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 S STAR LAKE RD APT 17-105
FEDERAL WAY WA
98003-3406
US

IV. Provider business mailing address

2211 S STAR LAKE RD APT 17-105
FEDERAL WAY WA
98003-3406
US

V. Phone/Fax

Practice location:
  • Phone: 253-250-6921
  • Fax:
Mailing address:
  • Phone: 253-250-6921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60154883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: