Provider Demographics
NPI:1063860161
Name:SOWE, MOMODOU
Entity Type:Individual
Prefix:
First Name:MOMODOU
Middle Name:
Last Name:SOWE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MOMODOU
Other - Middle Name:
Other - Last Name:SOWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-0214
Mailing Address - Country:US
Mailing Address - Phone:202-507-9826
Mailing Address - Fax:
Practice Address - Street 1:37885 CAPE HORN RD
Practice Address - Street 2:
Practice Address - City:CONCRETE
Practice Address - State:WA
Practice Address - Zip Code:98237-9233
Practice Address - Country:US
Practice Address - Phone:202-507-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00177316163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse