Provider Demographics
NPI:1215812847
Name:CHUMBA, SHADRACK KIPLAGAT
Entity type:Individual
Prefix:
First Name:SHADRACK
Middle Name:KIPLAGAT
Last Name:CHUMBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5421 57TH STREET CT W APT F1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4326
Mailing Address - Country:US
Mailing Address - Phone:336-693-1022
Mailing Address - Fax:
Practice Address - Street 1:5421 57TH STREET CT W APT F1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-4326
Practice Address - Country:US
Practice Address - Phone:336-693-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61536180163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse