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General NPI Number Information
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NPI Number | 1780408112
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Entity Type | Individual
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Provider Name | GEORGE MUHORO NDERITU
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Gender | Male
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4217 N MARINGO DR
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City | SPOKANE
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State | WA
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Zip | 99212-1865
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Country | US
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Telephone | 509-592-3579
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Fax | 509-924-2756
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Provider Business Mailing Address
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Address Line | 4217 N MARINGO DR
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City | SPOKANE
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State | WA
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Zip | 99212-1865
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Country | US
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Telephone | 509-592-3579
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Fax | 509-924-2756
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 754022
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License Number State | WA
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