Provider Demographics
NPI:1194592147
Name:OTIENO, CHARLINE ACHIENG
Entity type:Individual
Prefix:
First Name:CHARLINE
Middle Name:ACHIENG
Last Name:OTIENO
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 1:9902 24TH AVENUE CT S APT V304
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-7780
Mailing Address - Country:US
Mailing Address - Phone:253-229-9346
Mailing Address - Fax:
Practice Address - Street 1:4831 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2709
Practice Address - Country:US
Practice Address - Phone:206-937-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA60978173376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty