Healthcare Provider Details

I. General information

NPI: 1699629063
Provider Name (Legal Business Name): ETENESH KETEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 S OTHELLO ST UNIT 639
SEATTLE WA
98118-4095
US

IV. Provider business mailing address

4220 S OTHELLO ST UNIT 639
SEATTLE WA
98118-4095
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-2033
  • Fax:
Mailing address:
  • Phone: 206-227-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN60863124
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: