Healthcare Provider Details

I. General information

NPI: 1043857485
Provider Name (Legal Business Name): SERAH WANJIRU NJOROGE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14109 SE 282ND ST
KENT WA
98042-3916
US

IV. Provider business mailing address

1840 NE 129TH PL # 1
PORTLAND OR
97230-2215
US

V. Phone/Fax

Practice location:
  • Phone: 971-279-5130
  • Fax:
Mailing address:
  • Phone: 206-913-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00053265
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: