Provider Demographics
NPI:1972370989
Name:WAMBA, SHARON ATIENO
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ATIENO
Last Name:WAMBA
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 1:24858 145TH LN SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-3406
Mailing Address - Country:US
Mailing Address - Phone:206-775-1143
Mailing Address - Fax:
Practice Address - Street 1:24858 145TH LN SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-3406
Practice Address - Country:US
Practice Address - Phone:206-775-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61289157376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide