Provider Demographics
NPI:1336771377
Name:GATHU, MARYANN MUMBI (RN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:MUMBI
Last Name:GATHU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21525 SE 254TH PL
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7516
Mailing Address - Country:US
Mailing Address - Phone:206-856-6109
Mailing Address - Fax:206-260-3432
Practice Address - Street 1:21525 SE 254TH PL
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-7516
Practice Address - Country:US
Practice Address - Phone:206-856-6109
Practice Address - Fax:206-260-3432
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60467689163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse