Provider Demographics
NPI:1295069581
Name:AKONGO, ANNUCIATA (RN)
Entity type:Individual
Prefix:MS
First Name:ANNUCIATA
Middle Name:
Last Name:AKONGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OLYMPIA AVE NE
Mailing Address - Street 2:SUITE 255
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4117
Mailing Address - Country:US
Mailing Address - Phone:425-226-5373
Mailing Address - Fax:425-235-5703
Practice Address - Street 1:401 OLYMPIA AVE NE
Practice Address - Street 2:255
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4117
Practice Address - Country:US
Practice Address - Phone:425-226-5373
Practice Address - Fax:425-235-5703
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA163WH0200X163WH0200X
WA251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No251E00000XAgenciesHome Health