Provider Demographics
NPI:1720792302
Name:NDAMBUKI, ROBERT MUTISYA (CNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MUTISYA
Last Name:NDAMBUKI
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 1:218 NW SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2907
Mailing Address - Country:US
Mailing Address - Phone:509-592-8273
Mailing Address - Fax:509-715-1040
Practice Address - Street 1:218 NW SUNRISE DR
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2907
Practice Address - Country:US
Practice Address - Phone:509-592-8273
Practice Address - Fax:509-715-1040
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753235376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide