Healthcare Provider Details

I. General information

NPI: 1053128645
Provider Name (Legal Business Name): LAETITIA EKWY NJOKU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 165TH ST E
TACOMA WA
98445-4524
US

IV. Provider business mailing address

2521 165TH ST E
TACOMA WA
98445-4524
US

V. Phone/Fax

Practice location:
  • Phone: 206-250-4515
  • Fax: 253-204-2141
Mailing address:
  • Phone: 206-250-4515
  • Fax: 253-204-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60205892
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: