Provider Demographics
NPI:1104326651
Name:KIAMBUTHIA, GRACE WAIRIMU
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:WAIRIMU
Last Name:KIAMBUTHIA
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 1:2304 E 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6902
Mailing Address - Country:US
Mailing Address - Phone:469-456-2804
Mailing Address - Fax:509-315-8899
Practice Address - Street 1:2304 E 60TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6902
Practice Address - Country:US
Practice Address - Phone:469-456-2804
Practice Address - Fax:509-315-8899
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX931071163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse