Healthcare Provider Details

I. General information

NPI: 1134019938
Provider Name (Legal Business Name): YELUMA LIMA MONICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 112TH AVENUE CT E
PUYALLUP WA
98374-6519
US

IV. Provider business mailing address

19021 112TH AVENUE CT E
PUYALLUP WA
98374-6519
US

V. Phone/Fax

Practice location:
  • Phone: 425-394-8697
  • Fax:
Mailing address:
  • Phone: 425-394-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number61602489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: