Healthcare Provider Details

I. General information

NPI: 1356681019
Provider Name (Legal Business Name): TEKLE ZEWOLDAY EYSADIK RN00128551
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 - 226 ST SW
EDMONDS WA
98026
US

IV. Provider business mailing address

8102 - 226 ST SW
EDMONDS WA
98026
US

V. Phone/Fax

Practice location:
  • Phone: 206-963-7879
  • Fax:
Mailing address:
  • Phone: 206-963-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00128551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: