Provider Demographics
NPI:1215788971
Name:KIBABA, WILLIAM (CNA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KIBABA
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S 331ST ST
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-9468
Mailing Address - Country:US
Mailing Address - Phone:206-806-3176
Mailing Address - Fax:
Practice Address - Street 1:5197 NW LOWER RIVER RD BLDG 1
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1013
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC61388383376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide