Healthcare Provider Details

I. General information

NPI: 1558047589
Provider Name (Legal Business Name): HIRUT TAFESE GEBREHANNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 MANOR WAY UNIT A2
LYNNWOOD WA
98087-5702
US

IV. Provider business mailing address

13420 MANOR WAY UNIT A2
LYNNWOOD WA
98087-5702
US

V. Phone/Fax

Practice location:
  • Phone: 206-734-1577
  • Fax:
Mailing address:
  • Phone: 206-734-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN60895755
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: