Healthcare Provider Details

I. General information

NPI: 1154652758
Provider Name (Legal Business Name): JOHN KIHURIA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2010
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date: 01/11/2011
Reactivation Date: 06/21/2022

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

747 BROADWAY
SEATTLE WA
98122-4379
US

V. Phone/Fax

Practice location:
  • Phone: 206-992-8310
  • Fax:
Mailing address:
  • Phone: 206-992-8310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61628268
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00166715
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: