Individual
IDA BOJANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2205 MAPLE VALLEY HWY, 216, RENTON, WA 98057-3955
(425) 463-7625
Mailing address
2205 MAPLE VALLEY HWY, 216, RENTON, WA 98057-3955
(425) 463-7625
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP60015162
WA
Other
Enumeration date
11/05/2014
Last updated
11/05/2014
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