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General NPI Number Information
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NPI Number | 1306653753
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Entity Type | Individual
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Provider Name | PHATYM BAMBA EPSE KONE PC
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Gender | Female
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 16003 ADMIRALTY WAY APT D203
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City | LYNNWOOD
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State | WA
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Zip | 98087-6488
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Country | US
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Telephone | 425-678-5212
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Fax |
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Provider Business Mailing Address
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Address Line | 16003 ADMIRALTY WAY APT D203
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City | LYNNWOOD
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State | WA
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Zip | 98087-6488
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Country | US
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Telephone | 425-678-5212
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | NC61164097
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | PC61287625
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License Number State | WA
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