Provider Demographics
NPI:1407623903
Name:THENUTAI, DEBORAH (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:THENUTAI
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18840 NE 159TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-9148
Mailing Address - Country:US
Mailing Address - Phone:503-319-1179
Mailing Address - Fax:
Practice Address - Street 1:18840 NE 159TH ST
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-9148
Practice Address - Country:US
Practice Address - Phone:503-319-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00166455163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant