Provider Demographics
NPI:1407405657
Name:MIRIE, MARYANNE WAMBUI (RN)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:WAMBUI
Last Name:MIRIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22800 28TH AVE S
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-4439
Mailing Address - Country:US
Mailing Address - Phone:206-407-4435
Mailing Address - Fax:
Practice Address - Street 1:22800 28TH AVE S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-4439
Practice Address - Country:US
Practice Address - Phone:206-407-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60724733163W00000X
WAAP61557447363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse