Provider Demographics
NPI:1588315204
Name:PENDLE, DRUSSIRA (RN)
Entity type:Individual
Prefix:
First Name:DRUSSIRA
Middle Name:
Last Name:PENDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 NEWPORT ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-7006
Mailing Address - Country:US
Mailing Address - Phone:971-221-8319
Mailing Address - Fax:
Practice Address - Street 1:2127 NEWPORT ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-7006
Practice Address - Country:US
Practice Address - Phone:971-221-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60479660163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse