Healthcare Provider Details

I. General information

NPI: 1679469803
Provider Name (Legal Business Name): AZZAR ADEMASU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2119 3RD AVE
SEATTLE WA
98121-2333
US

IV. Provider business mailing address

15358 26TH AVE NE
SHORELINE WA
98155-7409
US

V. Phone/Fax

Practice location:
  • Phone: 206-374-9409
  • Fax:
Mailing address:
  • Phone: 206-694-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN61562421
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN61562421
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN61562421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: