Healthcare Provider Details

I. General information

NPI: 1275352510
Provider Name (Legal Business Name): BASHIR MAHMUD ANWAR ABUMENJEL REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 16TH AVE E
SEATTLE WA
98112-5226
US

IV. Provider business mailing address

201 16TH AVE E
SEATTLE WA
98112-5226
US

V. Phone/Fax

Practice location:
  • Phone: 206-326-4545
  • Fax: 206-326-4555
Mailing address:
  • Phone: 206-326-4545
  • Fax: 206-326-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN61033298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: