=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083427009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GEORGE WACHIRA GICHUKI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3732 W OLYMPIC AVE
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99205-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-863-9925
-----------------------------------------------------
Fax | 509-463-7678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3732 W OLYMPIC AVE
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99205-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-863-9925
-----------------------------------------------------
Fax | 509-463-7678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 61035936
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------