Healthcare Provider Details

I. General information

NPI: 1992569271
Provider Name (Legal Business Name): ALICE NJOROGE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3436 MARY ELDER RD NE
OLYMPIA WA
98506-5050
US

IV. Provider business mailing address

45138 W SANDHILL RD
MARICOPA AZ
85139-9102
US

V. Phone/Fax

Practice location:
  • Phone: 520-251-7547
  • Fax:
Mailing address:
  • Phone: 520-251-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61536378
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: