Healthcare Provider Details

I. General information

NPI: 1831087147
Provider Name (Legal Business Name): FANUS ASEFAW AREGAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33480 13TH PL S
FEDERAL WAY WA
98003-6357
US

IV. Provider business mailing address

7224 PACIFIC HWY E
MILTON WA
98354-9654
US

V. Phone/Fax

Practice location:
  • Phone: 253-285-7101
  • Fax:
Mailing address:
  • Phone: 253-205-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.RN.60957857.MSL
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: