Healthcare Provider Details

I. General information

NPI: 1780455329
Provider Name (Legal Business Name): TERRY NJERI NJOROGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SW 43RD ST STE 140
RENTON WA
98057-4803
US

IV. Provider business mailing address

25615 120TH PL SE
KENT WA
98030-7810
US

V. Phone/Fax

Practice location:
  • Phone: 425-264-0750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number60676018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: