Provider Demographics
NPI:1821607300
Name:MBUA, SAMWEL (ARNP)
Entity Type:Individual
Prefix:
First Name:SAMWEL
Middle Name:
Last Name:MBUA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:SAMWEL
Other - Middle Name:
Other - Last Name:MBUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:16110 8TH AVE SW STE A2
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2962
Mailing Address - Country:US
Mailing Address - Phone:206-246-1012
Mailing Address - Fax:206-242-4437
Practice Address - Street 1:16110 8TH AVE SW STE A2
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-246-1012
Practice Address - Fax:206-242-4437
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61086528363L00000X, 207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2167945Medicaid