Provider Demographics
NPI:1790550762
Name:ELIJAH, WINNIE MOKOBI
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:MOKOBI
Last Name:ELIJAH
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 1:19466 115TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-0074
Mailing Address - Country:US
Mailing Address - Phone:909-642-4326
Mailing Address - Fax:
Practice Address - Street 1:19466 115TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-0074
Practice Address - Country:US
Practice Address - Phone:909-642-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61386079376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide