Provider Demographics
NPI:1508221300
Name:ONYAMBU, STEPHEN (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ONYAMBU
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 GRANT AVE S APT 4
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3656
Mailing Address - Country:US
Mailing Address - Phone:253-266-8689
Mailing Address - Fax:
Practice Address - Street 1:11629 AVONDALE RD NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-2201
Practice Address - Country:US
Practice Address - Phone:425-653-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00057467164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse