Provider Demographics
NPI:1154891984
Name:MONAGHAN, LUZVIMINDA IMPERIAL
Entity type:Individual
Prefix:MRS
First Name:LUZVIMINDA
Middle Name:IMPERIAL
Last Name:MONAGHAN
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 1:611 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-6308
Mailing Address - Country:US
Mailing Address - Phone:253-292-7698
Mailing Address - Fax:
Practice Address - Street 1:12530 VINE MAPLE DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1134
Practice Address - Country:US
Practice Address - Phone:253-292-7698
Practice Address - Fax:253-328-5566
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753804163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator