Provider Demographics
NPI:1962147470
Name:CHEGE, ELIZABETH WACHUKA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WACHUKA
Last Name:CHEGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 16TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6406
Mailing Address - Country:US
Mailing Address - Phone:253-446-2902
Mailing Address - Fax:
Practice Address - Street 1:801 16TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-6406
Practice Address - Country:US
Practice Address - Phone:253-446-2902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC61143022376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide