Active NPI
Solomon Tibebu
- Registered Nurse
- Kent, WA
National Provider Identifier
1215538749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN60954301
- Practice address
- 505 Washington Ave S
Kent, WA 98032-5709 - Phone
- (253) 833-7444
- NPI assigned
- Nov 2, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN60954301 | WA | Primary |
Addresses
Primary practice location
505 Washington Ave S
Kent, WA 98032-5709
Mailing address
325 W Gowe St
Kent, WA 98032-5892
Phone (253) 833-7444
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN60954301 | WA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604275200000",
"number": "1215538749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 W GOWE ST",
"city": "KENT",
"state": "WA",
"postal_code": "980325892",
"telephone_number": "253-833-7444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 WASHINGTON AVE S",
"city": "KENT",
"state": "WA",
"postal_code": "980325709",
"telephone_number": "253-833-7444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIBEBU",
"first_name": "SOLOMON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-02",
"last_updated": "2020-11-02",
"certification_date": "2020-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WA",
"license": "RN60954301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.