Provider Demographics
NPI:1982595542
Name:LUMABAO, GINA (MSN, RN)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:LUMABAO
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23960 58TH CT S APT B1
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-3381
Mailing Address - Country:US
Mailing Address - Phone:731-394-6205
Mailing Address - Fax:
Practice Address - Street 1:23960 58TH CT S APT B1
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-3381
Practice Address - Country:US
Practice Address - Phone:401-405-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60139422163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse