Healthcare Provider Details

I. General information

NPI: 1598648099
Provider Name (Legal Business Name): TESFAYE GEBREYOHANNES I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

2009 N 154TH PL
SHORELINE WA
98133-6337
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-5856
  • Fax:
Mailing address:
  • Phone: 206-407-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60618180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: