Provider Demographics
NPI:1770198400
Name:KAMAU, IRENE WAMBUI
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:WAMBUI
Last Name:KAMAU
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 1:36244 23RD PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8369
Mailing Address - Country:US
Mailing Address - Phone:678-707-3234
Mailing Address - Fax:
Practice Address - Street 1:31821 34TH PL SW
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2235
Practice Address - Country:US
Practice Address - Phone:678-707-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60866963163W00000X
WAAP61074133363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse