Healthcare Provider Details

I. General information

NPI: 1316873722
Provider Name (Legal Business Name): TESHOME BEKELE ELEMA CN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4548 20TH AVE NE APT 101
SEATTLE WA
98105-3356
US

IV. Provider business mailing address

4548 20TH AVE NE APT 101
SEATTLE WA
98105-3356
US

V. Phone/Fax

Practice location:
  • Phone: 206-845-3676
  • Fax:
Mailing address:
  • Phone: 206-845-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNUTR.NU.70021536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: