Healthcare Provider Details

I. General information

NPI: 1508221300
Provider Name (Legal Business Name): STEPHEN ONYAMBU LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11629 AVONDALE RD NE
REDMOND WA
98052-2201
US

IV. Provider business mailing address

1811 GRANT AVE S APT 4
RENTON WA
98055-3656
US

V. Phone/Fax

Practice location:
  • Phone: 425-653-5070
  • Fax:
Mailing address:
  • Phone: 253-266-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP00057467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: