Healthcare Provider Details

I. General information

NPI: 1891684445
Provider Name (Legal Business Name): MAHRUMA KHATOON SIDDIQUA NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17446 NE 28TH ST
REDMOND WA
98052-6242
US

IV. Provider business mailing address

17446 NE 28TH ST
REDMOND WA
98052
US

V. Phone/Fax

Practice location:
  • Phone: 425-505-1477
  • Fax: 425-505-1477
Mailing address:
  • Phone: 425-505-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number61575883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: