Individual
KOUASSI KAN BOUA LAZARE ASSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
13806 123RD AVE NE, KIRKLAND, WA 98034-2248
(206) 384-2222
(425) 968-1999
Mailing address
1202 BERILLA DR, ENUMCLAW, WA 98022-8426
(206) 384-2222
(425) 968-1999
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61440338
WA
Other
Enumeration date
06/21/2023
Last updated
04/15/2024
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