Individual
IBRA N/A NIANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6433 40TH ST E, FIFE, WA 98424-2374
(360) 440-3586
Mailing address
6433 40TH ST E, FIFE, WA 98424-2374
(360) 440-3586
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN60246530
WA
Other
Enumeration date
08/20/2019
Last updated
08/20/2019
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