Provider Demographics
NPI:1215823646
Name:MUGI, TERESIAH
Entity type:Individual
Prefix:
First Name:TERESIAH
Middle Name:
Last Name:MUGI
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 1:420 S LEGG ST
Mailing Address - Street 2:
Mailing Address - City:MEDICAL LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99022-8903
Mailing Address - Country:US
Mailing Address - Phone:206-739-2262
Mailing Address - Fax:
Practice Address - Street 1:420 S LEGG ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8903
Practice Address - Country:US
Practice Address - Phone:206-739-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757800311ZA0620X
WALP61330941164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No164W00000XNursing Service ProvidersLicensed Practical Nurse