Provider Demographics
NPI:1790501831
Name:MBOTE, ROSE N
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:N
Last Name:MBOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:N
Other - Last Name:MBOTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:12910 81ST AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-7721
Mailing Address - Country:US
Mailing Address - Phone:206-436-9751
Mailing Address - Fax:
Practice Address - Street 1:12910 81ST AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-7721
Practice Address - Country:US
Practice Address - Phone:206-436-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61160054163W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse