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Individual

VIVIAN KISANGA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
18715 106TH AVENUE CT E, PUYALLUP, WA 98374-8735
(206) 759-0207
Mailing address
18715 106TH AVENUE CT E STE 260, PUYALLUP, WA 98374-8735
(817) 657-5107

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP132350
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61183787
WA

Other

Enumeration date
11/17/2016
Last updated
08/25/2022
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