Healthcare Provider Details
I. General information
NPI: 1861145120
Provider Name (Legal Business Name): F&M HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6824 19TH ST W # 256
UNIVERSITY PLACE WA
98466-5528
US
IV. Provider business mailing address
6824 19TH ST W # 256
UNIVERSITY PLACE WA
98466-5528
US
V. Phone/Fax
- Phone: 253-777-1423
- Fax: 253-777-1423
- Phone: 253-777-1423
- Fax: 253-777-1423
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MAGGIE
SEKERAMAYI
Title or Position: OWNER
Credential: MD
Phone: 253-777-1423