Provider Demographics
NPI:1003403858
Name:GITHU, EDWARD NGUGI (RN)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:NGUGI
Last Name:GITHU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18402 98TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-4005
Mailing Address - Country:US
Mailing Address - Phone:774-253-1363
Mailing Address - Fax:
Practice Address - Street 1:18402 98TH AVE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-4005
Practice Address - Country:US
Practice Address - Phone:774-253-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61092809163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse