Provider Demographics
NPI:1700253051
Name:MIYAOKA, CONSTANCIA (RN)
Entity Type:Individual
Prefix:
First Name:CONSTANCIA
Middle Name:
Last Name:MIYAOKA
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 1:1804 NW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2242
Mailing Address - Country:US
Mailing Address - Phone:206-859-3355
Mailing Address - Fax:206-456-6654
Practice Address - Street 1:1804 NW 200TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2242
Practice Address - Country:US
Practice Address - Phone:206-859-3355
Practice Address - Fax:206-456-6654
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60138368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse