Provider Demographics
NPI:1114620184
Name:KABUYA, JEAN SYLVAIN MISESO (RN)
Entity Type:Individual
Prefix:
First Name:JEAN SYLVAIN
Middle Name:MISESO
Last Name:KABUYA
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 1:16816 116TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9119
Mailing Address - Country:US
Mailing Address - Phone:206-850-9109
Mailing Address - Fax:
Practice Address - Street 1:11019 50TH AVE E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98446-5303
Practice Address - Country:US
Practice Address - Phone:206-850-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60975493163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse