Healthcare Provider Details

I. General information

NPI: 1770419657
Provider Name (Legal Business Name): ELIAZABETH A TAFESSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6047 NE 203RD ST KENMORE
KENMORE WA
98028-8530
US

IV. Provider business mailing address

6047 NE 203RD ST KENMORE
KENMORE WA
98028-8530
US

V. Phone/Fax

Practice location:
  • Phone: 206-816-5252
  • Fax: 206-816-5252
Mailing address:
  • Phone: 206-816-5252
  • Fax: 206-816-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: