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General NPI Number Information
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NPI Number | 1164113841
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Entity Type | Individual
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Provider Name | NIYA KARUKAMATTOM CHACKO
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Gender | Female
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Dates
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Enumeration Date | 05/15/2023
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 1550 N 115TH ST
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City | SEATTLE
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State | WA
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Zip | 98133-8401
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Country | US
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Telephone | 877-694-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 14510 38TH AVE W
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City | LYNNWOOD
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State | WA
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Zip | 98087-5390
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Country | US
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Telephone | 425-305-9007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN60948690
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License Number State | WA
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