Healthcare Provider Details

I. General information

NPI: 1609793157
Provider Name (Legal Business Name): EMILY CHEPNGENO BOR BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WOODLAND SQUARE LOOP SE
LACEY WA
98503-1045
US

IV. Provider business mailing address

2211 LAKEWOOD DR SE
OLYMPIA WA
98501-3076
US

V. Phone/Fax

Practice location:
  • Phone: 360-764-8400
  • Fax:
Mailing address:
  • Phone: 605-389-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: