Healthcare Provider Details

I. General information

NPI: 1942077292
Provider Name (Legal Business Name): LILIAN NYARIBO OTWORI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

IV. Provider business mailing address

1510 MUNICIPAL AVE APT B3
PLANO TX
75074-6236
US

V. Phone/Fax

Practice location:
  • Phone: 206-937-3700
  • Fax:
Mailing address:
  • Phone: 682-246-9410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNAC.NC.61411636
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: