Healthcare Provider Details

I. General information

NPI: 1700485919
Provider Name (Legal Business Name): YANIQUE RICIE NANA YAKAM AZAH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YANIQUE RICIE N/A NANA YAKAM ARNP

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 S 204TH ST STE 280
KENT WA
98032-1352
US

IV. Provider business mailing address

6811 S 204TH ST STE 280
KENT WA
98032-1352
US

V. Phone/Fax

Practice location:
  • Phone: 888-674-5871
  • Fax: 206-694-2291
Mailing address:
  • Phone: 888-674-5871
  • Fax: 206-694-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61097737
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: