Provider Demographics
NPI:1467226787
Name:KINYANJUI, TERESIA NJERI
Entity Type:Individual
Prefix:
First Name:TERESIA
Middle Name:NJERI
Last Name:KINYANJUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 20TH AVENUE CT SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-5114
Mailing Address - Country:US
Mailing Address - Phone:253-314-3206
Mailing Address - Fax:253-904-8202
Practice Address - Street 1:3013 20TH AVENUE CT SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-5114
Practice Address - Country:US
Practice Address - Phone:253-314-3206
Practice Address - Fax:253-904-8202
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60492811164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty