Healthcare Provider Details

I. General information

NPI: 1437094984
Provider Name (Legal Business Name): MARYAMA A EGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 QUEEN ANNE AVE N
SEATTLE WA
98109-4521
US

IV. Provider business mailing address

13018 SE 308TH ST
AUBURN WA
98092-3284
US

V. Phone/Fax

Practice location:
  • Phone: 503-388-8110
  • Fax:
Mailing address:
  • Phone: 503-388-8110
  • Fax: 503-388-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP70114644
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70114644
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: