Provider Demographics
NPI:1558069062
Name:JENG, ADAMA (RN-BSN)
Entity type:Individual
Prefix:
First Name:ADAMA
Middle Name:
Last Name:JENG
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 153RD PL SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5237
Mailing Address - Country:US
Mailing Address - Phone:425-931-7475
Mailing Address - Fax:
Practice Address - Street 1:252 153RD PL SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5237
Practice Address - Country:US
Practice Address - Phone:425-931-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00173412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWDL6PS3CJ43BOtherSTATE DRIVER'S LICENSE