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Individual

FONABEI AYONGABA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
605 WOODLAND SQUARE LOOP SE, LACEY, WA 98503-1045
(844) 949-8888
Mailing address
325 W GOWE ST, KENT, WA 98032-5892
(253) 833-7444

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN61094794
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61475276
WA

Other

Enumeration date
01/25/2023
Last updated
09/06/2023
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