Provider Demographics
NPI:1558044354
Name:MUKUA, MARITHA (RN)
Entity Type:Individual
Prefix:
First Name:MARITHA
Middle Name:
Last Name:MUKUA
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 1:3110 SW 346TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3112
Mailing Address - Country:US
Mailing Address - Phone:253-329-0655
Mailing Address - Fax:
Practice Address - Street 1:3110 SW 346TH PL
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3112
Practice Address - Country:US
Practice Address - Phone:253-329-0655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60475592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse