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NPI Code Detail

MEDICARE: THEOPHILE KOUAM PEUMEU LPN

MEDICARE: THEOPHILE KOUAM PEUMEU LPN
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
1164W00000XLicensed Practical NurseLP00059330WA

General Provider Information

NPI Number : 1629515846
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEOPHILE KOUAM PEUMEU LPN
Provider Business Mailing Address
First Line : 6512 208TH ST SW
Second Line : APT. F11
City : LYNNWOOD
State : WA
Zip : 98036-7436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3512 ALBION PL N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-8875
Country : US
Telephone Number : 206-461-6990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2017
Last Update Date : 01/25/2017

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