Healthcare Provider Details

I. General information

NPI: 1619887619
Provider Name (Legal Business Name): ALEMTSEHAY MENGESTU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11350 SE 212TH ST
KENT WA
98031-2151
US

IV. Provider business mailing address

11350 SE 212TH ST
KENT WA
98031-2151
US

V. Phone/Fax

Practice location:
  • Phone: 206-551-5264
  • Fax: 253-478-3955
Mailing address:
  • Phone: 206-551-5264
  • Fax: 253-478-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: