MEDICARE: MRS. PATIENCE WAMBUI MBURU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN60375142	WA

General Provider Information

NPI Number	:	1205597796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATIENCE WAMBUI MBURU

Provider Business Mailing Address
First Line	:	2318 165TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-4928
Country	:	US
Telephone Number	:	704-780-5124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2318 165TH AVENUE CT E
Second Line	:
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-4928
Country	:	US
Telephone Number	:	704-780-5124
Fax Number	:	253-409-2806

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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