Healthcare Provider Details

I. General information

NPI: 1588509343
Provider Name (Legal Business Name): SULAYMAN JAGNE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 199TH AVE SE
MONROE WA
98272-8509
US

IV. Provider business mailing address

13768 199TH AVE SE
MONROE WA
98272-8509
US

V. Phone/Fax

Practice location:
  • Phone: 206-979-5267
  • Fax:
Mailing address:
  • Phone: 206-979-5267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN60021427
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: