Provider Demographics
NPI:1659164184
Name:GATHURA, SAMUEL WAIREGI
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WAIREGI
Last Name:GATHURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 25TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3354
Mailing Address - Country:US
Mailing Address - Phone:206-308-9681
Mailing Address - Fax:
Practice Address - Street 1:5105 25TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-3354
Practice Address - Country:US
Practice Address - Phone:206-308-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757244251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health