Healthcare Provider Details

I. General information

NPI: 1578333589
Provider Name (Legal Business Name): MICHAEL NYASANI KINGOINA ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 N 107TH ST STE 480
SEATTLE WA
98133-9009
US

IV. Provider business mailing address

20804 77TH ST E
BONNEY LAKE WA
98391-8766
US

V. Phone/Fax

Practice location:
  • Phone: 866-686-2504
  • Fax:
Mailing address:
  • Phone: 425-269-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61512716
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: