=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689583999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IROKO BRIDGE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2026
-----------------------------------------------------
Last Update Date | 09/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5219 N SHIRLEY ST STE 4
-----------------------------------------------------
City | RUSTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98407-6599
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-1683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3735 N VILLARD ST
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98407-3523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-200-1683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS MANAGER & ADMINISTRATOR
-----------------------------------------------------
Name | MEGAN COOK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-200-1683
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------