Healthcare Provider Details

I. General information

NPI: 1194643262
Provider Name (Legal Business Name): MERHAWIT TESFAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31003 14TH AVE S APT D23
FEDERAL WAY WA
98003-9012
US

IV. Provider business mailing address

31003 14TH AVE S APT D23
FEDERAL WAY WA
98003-9012
US

V. Phone/Fax

Practice location:
  • Phone: 605-231-3674
  • Fax:
Mailing address:
  • Phone: 605-231-3674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: