Healthcare Provider Details

I. General information

NPI: 1205776259
Provider Name (Legal Business Name): BONFACE MAINA MUNIU PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E MAIN ST
ELMA WA
98541-9560
US

IV. Provider business mailing address

600 E MAIN ST
ELMA WA
98541-9560
US

V. Phone/Fax

Practice location:
  • Phone: 360-763-9789
  • Fax:
Mailing address:
  • Phone: 360-763-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70149634-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: