Provider Demographics
NPI:1336710292
Name:NYAKAWA, SAMUEL NYABICHA
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:NYABICHA
Last Name:NYAKAWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 DIBBLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-3247
Mailing Address - Country:US
Mailing Address - Phone:206-277-3631
Mailing Address - Fax:
Practice Address - Street 1:8536 DIBBLE AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-3247
Practice Address - Country:US
Practice Address - Phone:206-277-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider