MEDICARE: ELIZABETH JINGUJI

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	00074315	WA

General Provider Information

NPI Number	:	1548652001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JINGUJI

Provider Business Mailing Address
First Line	:	3213 WILDWOOD PARK DR
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-1351
Country	:	US
Telephone Number	:	253-841-8673
Fax Number	:	253-840-8855

Provider Business Practice Location Address
First Line	:	3213 WILDWOOD PARK DR
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-1351
Country	:	US
Telephone Number	:	253-841-8673
Fax Number	:	253-840-8855

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

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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