MEDICARE: PRISCILLAH WARIARA WAWERU

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	376G00000X	Nursing Home Administrator	758976	WA

General Provider Information

NPI Number	:	1578497798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLAH WARIARA WAWERU

Provider Business Mailing Address
First Line	:	4480 SAIL LN SW
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-8777
Country	:	US
Telephone Number	:	360-507-1240
Fax Number	:	206-260-8808

Provider Business Practice Location Address
First Line	:	4480 SAIL LN SW
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-8777
Country	:	US
Telephone Number	:	360-507-1240
Fax Number	:	206-260-8808

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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