Provider Demographics
NPI:1265058416
Name:WAITHAKA, PATRICIA WACHUKA (NAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:WACHUKA
Last Name:WAITHAKA
Suffix:
Gender:F
Credentials:NAC
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:WACHUKA
Other - Last Name:WAITHAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:PO BOX 39311
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-3311
Mailing Address - Country:US
Mailing Address - Phone:253-341-9642
Mailing Address - Fax:
Practice Address - Street 1:10828 GRAVELLY LAKE DR SW STE 109
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1300
Practice Address - Country:US
Practice Address - Phone:253-341-9642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60811111374U00000X
WANC61124566376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide