Provider Demographics
NPI:1215704432
Name:GICHUKI, GEORGE G
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:G
Last Name:GICHUKI
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 1:1300 SW CAMPUS DR APT 71-1
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-5832
Mailing Address - Country:US
Mailing Address - Phone:206-970-9040
Mailing Address - Fax:
Practice Address - Street 1:1300 SW CAMPUS DR APT 71-1
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-5832
Practice Address - Country:US
Practice Address - Phone:206-970-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty