Provider Demographics
NPI:1881297224
Name:WAWERU, ELIZABETH W
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:WAWERU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33710 9TH AVE S STE 16
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6734
Mailing Address - Country:US
Mailing Address - Phone:253-235-5535
Mailing Address - Fax:
Practice Address - Street 1:33710 9TH AVE S STE 16
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6734
Practice Address - Country:US
Practice Address - Phone:253-235-5535
Practice Address - Fax:253-517-7408
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61090653251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health