Healthcare Provider Details

I. General information

NPI: 1417634379
Provider Name (Legal Business Name): SHEWIT GELE BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SOUTHCENTER BLVD
TUKWILA WA
98188-2547
US

IV. Provider business mailing address

PMB 6489 PO BOX 257
OLYMPIA WA
98507
US

V. Phone/Fax

Practice location:
  • Phone: 253-285-3316
  • Fax:
Mailing address:
  • Phone: 253-285-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60946006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: