Provider Demographics
NPI:1639515422
Name:NWOKOBIA, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:NWOKOBIA
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 1:6808 220TH ST SW STE 203
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2187
Mailing Address - Country:US
Mailing Address - Phone:425-776-1056
Mailing Address - Fax:425-412-6274
Practice Address - Street 1:6808 220TH ST SW STE 203
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2187
Practice Address - Country:US
Practice Address - Phone:425-776-1056
Practice Address - Fax:425-412-6274
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60338162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist