Healthcare Provider Details

I. General information

NPI: 1326515503
Provider Name (Legal Business Name): WILMA DAR MANGIDOYOS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10344 14TH AVE S
SEATTLE WA
98168-1689
US

IV. Provider business mailing address

11412 SE 193RD TER
KENT WA
98031-0038
US

V. Phone/Fax

Practice location:
  • Phone: 206-245-1086
  • Fax:
Mailing address:
  • Phone: 206-209-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00163599
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: