=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205606019
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSE N MULWA NA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2024
-----------------------------------------------------
Last Update Date | 01/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9400 RAINIER 9400 RAINIER AVE SOUTH APT 459
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 125-331-6057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 RAINIER 9400 RAINIER AVE SOUTH APT 459
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 125-331-6057
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | NC61276168
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------