Healthcare Provider Details

I. General information

NPI: 1013830892
Provider Name (Legal Business Name): EKAETTE AMANDA ANGELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 N SHIRLEY ST STE 4
RUSTON WA
98407-6599
US

IV. Provider business mailing address

3735 N VILLARD ST
TACOMA WA
98407-3523
US

V. Phone/Fax

Practice location:
  • Phone: 253-200-1683
  • Fax: 253-642-8590
Mailing address:
  • Phone: 253-200-1683
  • Fax: 253-642-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9207117
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: