Provider Demographics
NPI:1083462204
Name:NDUATI, JAMES NDUNGU
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NDUNGU
Last Name:NDUATI
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 1:10549 190TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9779
Mailing Address - Country:US
Mailing Address - Phone:206-816-4661
Mailing Address - Fax:
Practice Address - Street 1:10549 190TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-9779
Practice Address - Country:US
Practice Address - Phone:206-816-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA756862372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion