Healthcare Provider Details

I. General information

NPI: 1457266736
Provider Name (Legal Business Name): ANNE MUKIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21719 103RD AVENUE CT E UNIT 501-502
GRAHAM WA
98338-8169
US

IV. Provider business mailing address

12104 172ND STREET CT E
PUYALLUP WA
98374-4509
US

V. Phone/Fax

Practice location:
  • Phone: 253-440-1438
  • Fax: 253-364-1918
Mailing address:
  • Phone: 253-440-1438
  • Fax: 253-364-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number70165810
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: