Individual
MONDE IMBULA COFFEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
505 29TH ST SE, AUBURN, WA 98002-7541
(253) 876-7650
Mailing address
6400 SOUTHCENTER BLVD, TUKWILA, WA 98188-2547
(206) 901-2000
(206) 901-2010
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60647563
WA
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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