Healthcare Provider Details

I. General information

NPI: 1205577624
Provider Name (Legal Business Name): RASHIDA IRFAN ULLAH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S VASSAULT ST
TACOMA WA
98465-2008
US

IV. Provider business mailing address

PO BOX 368
PUYALLUP WA
98371-0038
US

V. Phone/Fax

Practice location:
  • Phone: 253-444-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61305421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: