Provider Demographics
NPI:1497564108
Name:WAINAINA, ANN JACKIELINE WAMBUI
Entity type:Individual
Prefix:
First Name:ANN JACKIELINE
Middle Name:WAMBUI
Last Name:WAINAINA
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 1:6926 5TH CT SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1416
Mailing Address - Country:US
Mailing Address - Phone:425-524-7471
Mailing Address - Fax:
Practice Address - Street 1:6926 5TH CT SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1416
Practice Address - Country:US
Practice Address - Phone:425-524-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities