Provider Demographics
NPI:1487130779
Name:BAMASH, NELLY WANJIRU (LPN)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:WANJIRU
Last Name:BAMASH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MERCY
Other - Middle Name:WANJIRU
Other - Last Name:BAMASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:9500 FRONT ST S STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-9415
Mailing Address - Country:US
Mailing Address - Phone:253-584-3996
Mailing Address - Fax:253-589-1071
Practice Address - Street 1:9500 FRONT ST S STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-9415
Practice Address - Country:US
Practice Address - Phone:253-584-3996
Practice Address - Fax:253-589-1071
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60720788164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALP60720788OtherLPN