Provider Demographics
NPI:1891551883
Name:BAKONGA, MYRIAM BOKAKO
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:BOKAKO
Last Name:BAKONGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRIAM
Other - Middle Name:OTSHITSHI
Other - Last Name:OKOKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2824 176TH ST NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4781
Mailing Address - Country:US
Mailing Address - Phone:325-407-3839
Mailing Address - Fax:
Practice Address - Street 1:2824 176TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4781
Practice Address - Country:US
Practice Address - Phone:325-407-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWDL52P20843B171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty