Provider Demographics
NPI:1144812009
Name:BAGALWA, MIRIAM NEEMA (NP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:NEEMA
Last Name:BAGALWA
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:15127 MAIN ST E UNIT 104
Mailing Address - Street 2:PMB 231
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-2689
Mailing Address - Country:US
Mailing Address - Phone:253-642-4104
Mailing Address - Fax:206-673-8050
Practice Address - Street 1:33530 1ST WAY S STE 102
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7332
Practice Address - Country:US
Practice Address - Phone:206-915-6166
Practice Address - Fax:206-673-8050
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2025-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61149727363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health