Provider Demographics
NPI:1316762941
Name:MAINA, SIMON N (RN)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:N
Last Name:MAINA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12121 130TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-4443
Mailing Address - Country:US
Mailing Address - Phone:732-582-9512
Mailing Address - Fax:253-693-9963
Practice Address - Street 1:12121 130TH AVENUE CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-4443
Practice Address - Country:US
Practice Address - Phone:732-582-9512
Practice Address - Fax:253-693-9963
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA61251580163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse