Provider Demographics
NPI:1073380440
Name:GICHURU, GEORGE GACHOMBA (CNA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:GACHOMBA
Last Name:GICHURU
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20810 56TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-4750
Mailing Address - Country:US
Mailing Address - Phone:206-355-6863
Mailing Address - Fax:
Practice Address - Street 1:20810 56TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-4750
Practice Address - Country:US
Practice Address - Phone:206-355-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60745063251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care