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General NPI Number Information
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NPI Number | 1861576761
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Entity Type | Individual
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Provider Name | NABATANZI AGNES BEWAYO M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 402 S 333RD ST STE 105
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7099
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Country | US
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Telephone | 971-251-5788
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 58608
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City | RENTON
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State | WA
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Zip | 98058-1608
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Country | US
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Telephone | 404-558-3404
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 047964
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60752475
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License Number State | WA
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