Provider Demographics
NPI:1891556551
Name:BUGONZI, MARGARET KYEMBA
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:KYEMBA
Last Name:BUGONZI
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 1:407 VALLEY AVE NE APT F306
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-2585
Mailing Address - Country:US
Mailing Address - Phone:971-901-7190
Mailing Address - Fax:
Practice Address - Street 1:407 VALLEY AVE NE APT F306
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-2585
Practice Address - Country:US
Practice Address - Phone:971-901-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61471551253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care