Healthcare Provider Details

I. General information

NPI: 1811510662
Provider Name (Legal Business Name): FATUMA HASSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21907 64TH AVE W STE 200
MOUNTLAKE TERRACE WA
98043-6200
US

IV. Provider business mailing address

100 N HOWARD ST STE R
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61392003
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: