Provider Demographics
NPI:1225808108
Name:MAINA, JEDIDAH WANGOI
Entity type:Individual
Prefix:MRS
First Name:JEDIDAH
Middle Name:WANGOI
Last Name:MAINA
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 1:2909 DALE LN E
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-2305
Mailing Address - Country:US
Mailing Address - Phone:206-319-2945
Mailing Address - Fax:253-517-8476
Practice Address - Street 1:2909 DALE LN E
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-2305
Practice Address - Country:US
Practice Address - Phone:206-319-2945
Practice Address - Fax:253-517-8476
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6081956376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide