Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60964165 | WA |
NPI | 1013574243 |
---|---|
Provider Name | Jane Nwankwookoye |
First Address | Seattle, WA 98122-5959 |
Second Address | Renton, WA 98057-2161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2019 |
Last Update Date | 22/05/2019 |