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General NPI Number Information
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NPI Number | 1659875078
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Entity Type | Individual
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Provider Name | KYLAR RONELLE MEHALIK CNA
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE ATTN MCHJ-CLQ-C
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-3869
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Fax |
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Provider Business Mailing Address
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Address Line | 11822 78TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98373-4870
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Country | US
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Telephone | 253-380-4920
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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 | NC60683896
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License Number State | WA
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