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4630 200th St Sw Ste F Lynnwood WA 98036-6608 | |
| (425) 510-1196 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4630 200th St Sw Ste F, Lynnwood, Washington |
| Authorized Official Name and Position | Alexandria Gomez (ADMINISTRATIVE MANAGER) |
| Authorized Official Contact | 4256700280 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4630 200th St Sw Ste F Lynnwood WA 98036-6608 Ph: (425) 510-1196 | 4630 200th St Sw Ste F Lynnwood WA 98036-6608 Ph: (425) 510-1196 |
| NPI Number | 1073198602 |
|---|---|
| Provider Enumeration Date | 03/15/2021 |
| Last Update Date | 06/02/2022 |
| Certification Date | 06/02/2022 |
| Medicare PECOS PAC ID | 6103229240 |
|---|---|
| Medicare Enrollment ID | O20210727001224 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073198602 | NPI | - | NPPES |
| 217358300 | Medicaid | WA |
| Provider Name | Mary A. Gumbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962928861 PECOS PAC ID: 6800129982 Enrollment ID: I20190604002224 |
| Provider Name | Mercy N Wainaina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427605609 PECOS PAC ID: 2163855669 Enrollment ID: I20191212002966 |
| Provider Name | Anabel Bijemia Sema |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720699473 PECOS PAC ID: 8820488976 Enrollment ID: I20211202003119 |
| Provider Name | Catherine Wanjiru Donnerstag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700557477 PECOS PAC ID: 8820479868 Enrollment ID: I20220721001898 |
| Provider Name | Robert J Wamukoya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558007930 PECOS PAC ID: 8729463625 Enrollment ID: I20220913002460 |
| Provider Name | Chioma Imelda Eze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912518432 PECOS PAC ID: 7113339904 Enrollment ID: I20230323002571 |
| Provider Name | Gagandeep Mundi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124748363 PECOS PAC ID: 9739549643 Enrollment ID: I20230724001481 |
| Provider Name | Abubeker Hussien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255036125 PECOS PAC ID: 6002279908 Enrollment ID: I20230824003410 |
| Provider Name | Elizabeth Adebayo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093427726 PECOS PAC ID: 5698148419 Enrollment ID: I20241014001469 |
| Provider Name | Sisay Faynato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679303564 PECOS PAC ID: 3577098441 Enrollment ID: I20241202001683 |
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