Provider Demographics
NPI:1831963248
Name:MWANGI, SIMON N
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:N
Last Name:MWANGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 FIR CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9389
Mailing Address - Country:US
Mailing Address - Phone:206-330-7559
Mailing Address - Fax:253-517-9882
Practice Address - Street 1:2311 FIR CT
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9389
Practice Address - Country:US
Practice Address - Phone:206-330-7559
Practice Address - Fax:253-517-9882
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60783322374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide