Healthcare Provider Details

I. General information

NPI: 1871472381
Provider Name (Legal Business Name): GIRMACHEW TEFERA MEKONNNEN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14126 SE 167TH ST
RENTON WA
98058-8507
US

IV. Provider business mailing address

1550 N 115TH ST
SEATTLE WA
98133-8401
US

V. Phone/Fax

Practice location:
  • Phone: 206-841-7111
  • Fax:
Mailing address:
  • Phone: 206-668-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberLR60097141
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: