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General NPI Number Information
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NPI Number | 1679092704
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Entity Type | Individual
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Provider Name | BETHELL ASSEFA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2017
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 21907 64TH AVE W
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2200
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Country | US
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Telephone | 206-769-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 427 125TH ST SE
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City | EVERETT
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State | WA
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Zip | 98208-6413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP60781549
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RN60673768
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60781549
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License Number State | WA
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