Healthcare Provider Details

I. General information

NPI: 1528948718
Provider Name (Legal Business Name): SAMRA E IDRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 VILLAGE PARK DR SE APT 1512
BELLEVUE WA
98006-5585
US

IV. Provider business mailing address

5303 VILLAGE PARK DR SE APT 1512
BELLEVUE WA
98006-5585
US

V. Phone/Fax

Practice location:
  • Phone: 206-698-5568
  • Fax:
Mailing address:
  • Phone: 206-698-5568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: