Provider Demographics
NPI:1770158172
Name:MARAMBA, AGNES ANDAL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:AGNES
Middle Name:ANDAL
Last Name:MARAMBA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:AGNES
Other - Middle Name:ANDAL
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:19435 68TH AVE S STE S102
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2114
Mailing Address - Country:US
Mailing Address - Phone:253-414-1983
Mailing Address - Fax:
Practice Address - Street 1:19435 68TH AVE S STE S102
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-2114
Practice Address - Country:US
Practice Address - Phone:253-414-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61625569363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health