Provider Demographics
NPI:1861246688
Name:NJERE, CAROLINE (PROVIDER)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:NJERE
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 24TH STREET CT NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-4307
Mailing Address - Country:US
Mailing Address - Phone:253-252-2644
Mailing Address - Fax:
Practice Address - Street 1:6610 24TH STREET CT NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-4307
Practice Address - Country:US
Practice Address - Phone:253-252-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA757085311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home