MEDICARE: DELINA MUSSIE IYASSU SEYOUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula		WA

General Provider Information

NPI Number	:	1427879162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELINA MUSSIE IYASSU SEYOUM

Provider Business Mailing Address
First Line	:	7089 HOLLY PARK DR S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3525
Country	:	US
Telephone Number	:	602-399-9441
Fax Number	:

Provider Business Practice Location Address
First Line	:	7089 HOLLY PARK DR S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3525
Country	:	US
Telephone Number	:	602-399-9441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	10/23/2024

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