Healthcare Provider Details

I. General information

NPI: 1619880671
Provider Name (Legal Business Name): THEOPHILLE GAHONGAYIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E 72ND ST
TACOMA WA
98404-3344
US

IV. Provider business mailing address

8520 25TH ST W APT 101
UNIVERSITY PLACE WA
98466-8282
US

V. Phone/Fax

Practice location:
  • Phone: 253-319-8399
  • Fax:
Mailing address:
  • Phone: 575-621-6357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number70147772
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: